The iHOPE-20 study: Relationships between and prospective predictors of remission, clinical recovery, personal recovery and resilience 20 years on from a first episode psychosis

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Abstract

Objective:

Knowledge of outcome in psychotic illness is limited by the paucity of very long-term epidemiologically representative studies of incidence first episode psychosis (FEP) cohorts that measure and compare outcomes reflecting modern clinical practice, mental health policy and research agendas. Our study aimed to address this gap.

Method:

iHOPE-20 is a prospective 20-year follow-up study of a FEP incidence cohort ( N = 171) conducted between 2014 and 2017 in Ireland. Data from previous studies and medical records were used to recruit cohort members. We assessed remission, clinical recovery, personal recovery and resilience at 20 years; explored the relationships between these outcomes and examined the predictive value of baseline characteristics in determining them.

Results:

At follow-up, 20 out of 171 cohort members (11.70%) were deceased. We assessed 80 out of 151 alive cohort members (53% recruitment rate); 65% were in remission; 35.2% were in Full Functional Recovery and 53.7% confirmed they were fully recovered according to their personal definition of recovery. A complex array of relationships between outcomes was found. Outcomes were better for people who had a short duration of untreated psychosis, displayed higher premorbid social adjustment (between the ages of 5–11) and at baseline, were older, not living alone, in full-time employment, given a non-affective diagnosis, and had lower Global Assessment of Functioning scores.

Conclusion:

Among participants, full remission of psychotic symptoms and personally defined recovery was not just possible but likely in the very long term. However, attaining positive functional outcomes and building resilience in FEP remain key challenges for mental health services.

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Most cited references 44

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Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC).

Kathryn M Connor, Jonathan Davidson (2003)

Resilience may be viewed as a measure of stress coping ability and, as such, could be an important target of treatment in anxiety, depression, and stress reactions. We describe a new rating scale to assess resilience. The Connor-Davidson Resilience scale (CD-RISC) comprises of 25 items, each rated on a 5-point scale (0-4), with higher scores reflecting greater resilience. The scale was administered to subjects in the following groups: community sample, primary care outpatients, general psychiatric outpatients, clinical trial of generalized anxiety disorder, and two clinical trials of PTSD. The reliability, validity, and factor analytic structure of the scale were evaluated, and reference scores for study samples were calculated. Sensitivity to treatment effects was examined in subjects from the PTSD clinical trials. The scale demonstrated good psychometric properties and factor analysis yielded five factors. A repeated measures ANOVA showed that an increase in CD-RISC score was associated with greater improvement during treatment. Improvement in CD-RISC score was noted in proportion to overall clinical global improvement, with greatest increase noted in subjects with the highest global improvement and deterioration in CD-RISC score in those with minimal or no global improvement. The CD-RISC has sound psychometric properties and distinguishes between those with greater and lesser resilience. The scale demonstrates that resilience is modifiable and can improve with treatment, with greater improvement corresponding to higher levels of global improvement. Copyright 2003 Wiley-Liss, Inc.

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The positive and negative syndrome scale (PANSS) for schizophrenia.

L Opler, Jennifer Kay, Paul Opler … (1986)

The variable results of positive-negative research with schizophrenics underscore the importance of well-characterized, standardized measurement techniques. We report on the development and initial standardization of the Positive and Negative Syndrome Scale (PANSS) for typological and dimensional assessment. Based on two established psychiatric rating systems, the 30-item PANSS was conceived as an operationalized, drug-sensitive instrument that provides balanced representation of positive and negative symptoms and gauges their relationship to one another and to global psychopathology. It thus constitutes four scales measuring positive and negative syndromes, their differential, and general severity of illness. Study of 101 schizophrenics found the four scales to be normally distributed and supported their reliability and stability. Positive and negative scores were inversely correlated once their common association with general psychopathology was extracted, suggesting that they represent mutually exclusive constructs. Review of five studies involving the PANSS provided evidence of its criterion-related validity with antecedent, genealogical, and concurrent measures, its predictive validity, its drug sensitivity, and its utility for both typological and dimensional assessment.

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Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review.

Max Marshall, Shôn Lewis, Austin Lockwood … (2005)

Duration of untreated psychosis (DUP) is the time from manifestation of the first psychotic symptom to initiation of adequate treatment. It has been postulated that a longer DUP leads to a poorer prognosis. If so, outcome might be improved through earlier detection and treatment. To establish whether DUP is associated with prognosis and to determine whether any association is explained by confounding with premorbid adjustment. The CINAHL (Cumulative Index to Nursing and Allied Health), EMBASE, MEDLINE, and PsychLIT databases were searched from their inception dates to May 2004. Eligible studies reported the relationship between DUP and outcome in prospective cohorts recruited during their first episode of psychosis. Twenty-six eligible studies involving 4490 participants were identified from 11 458 abstracts, each screened by 2 reviewers. Data were extracted independently and were checked by double entry. Sensitivity analyses were conducted excluding studies that had follow-up rates of less than 80%, included affective psychoses, or did not use a standardized assessment of DUP. Independent meta-analyses were conducted of correlational data and of data derived from comparisons of long and short DUP groups. Most data were correlational, and these showed a significant association between DUP and several outcomes at 6 and 12 months (including total symptoms, depression/anxiety, negative symptoms, overall functioning, positive symptoms, and social functioning). Long vs short DUP data showed an association between longer DUP and worse outcome at 6 months in terms of total symptoms, overall functioning, positive symptoms, and quality of life. Patients with a long DUP were significantly less likely to achieve remission. The observed association between DUP and outcome was not explained by premorbid adjustment. There is convincing evidence of a modest association between DUP and outcome, which supports the case for clinical trials that examine the effect of reducing DUP.

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Author and article information

Journal

Journal ID (nlm-ta): Aust N Z J Psychiatry

Journal ID (iso-abbrev): Aust N Z J Psychiatry

Journal ID (publisher-id): ANP

Journal ID (hwp): spanp

Title: The Australian and New Zealand Journal of Psychiatry

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Print): 0004-8674

ISSN (Electronic): 1440-1614

Publication date (Electronic): 06 February 2019

Publication date (Print): November 2019

Volume: 53

Issue: 11

Pages: 1080-1092

Affiliations

[1 ]DETECT Early Intervention in Psychosis Service, Dublin, Ireland

[2 ]School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin, Ireland

[3 ]Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland

[4 ]Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland

[5 ]School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland

[6 ]Research Department, Saint John of God Hospitaller Services, Dublin, Ireland

[7 ]St. John of God Community Services, Dublin, Ireland

[8 ]School of Postgraduate Studies, Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland

[9 ]School of Medicine, University College Dublin, Dublin, Ireland

Author notes

[*]Donal O’Keeffe, DETECT Early Intervention in Psychosis Service, Avila House, Block 5, Blackrock Business Park, Blackrock, Co. Dublin A94 Y030, Ireland. Email: donal.okeeffe@ 123456sjog.ie

Author information

Donal O’Keeffe https://orcid.org/0000-0001-6541-996X

Article

Publisher ID: 10.1177_0004867419827648

DOI: 10.1177/0004867419827648

PMC ID: 6826887

PubMed ID: 30722671

SO-VID: 27059cc4-57ad-404f-a64e-07b839fc8568

License:

This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( http://www.creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Funding

Funded by: Health Research Board of Ireland, ;

Award ID: HRA_HSR/2013.409

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The iHOPE-20 study: Relationships between and prospective predictors of remission, clinical recovery, personal recovery and resilience 20 years on from a first episode psychosis

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Abstract

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Results:

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Most cited references 44

Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC).

The positive and negative syndrome scale (PANSS) for schizophrenia.

Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review.

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