Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

New research indicates more positive outlook for people diagnosed with first-episode psychosis

08 December 2017
For the first time in psychosis research, a large meta-analysis of remission and recovery was conducted. The study found that 58% of patients with first episode psychosis were likely to experience remission (over an average follow up of 5.5 years), while 38% are likely to experience recovery (over an average follow up of 7.2 years). This is higher than previously identified remission and recovery rates.
 
Remission is defined as absent psychotic symptoms for at least six months. Recovery is defined as both symptomatic and functional improvement (including social, educational and occupational domains) for at least two years. 

A key factor behind the difference in remission and recovery rates identified in this research is that previous reviews included people with both first-episode and multi-episode disorders. Multi-episode patients include those with more chronic or treatment resistant illness, who would be expected to have lower recovery rates. A previous review in schizophrenia identified that only 1 in 7 patients had a functional recovery. This study identifies that 1 in 3 of people with a first episode schizophrenia will meet criteria for recovery. 
 
The research also identified stability of recovery rates after the first two years, suggesting that a progressive deterioration of the illness is not typical. 
 
According to Dr John Lally, “Despite the increased focus on the early recognition and treatment of first episode psychosis over the past two decades, there had been no analysis of remission and recovery rates. Until now the prognosis for those diagnosed with first episode psychosis was bleak. What we have discovered gives hope that they have a much better chance of experiencing a long-term recovery than previously understood”.  “Our finding that recovery rates have not improved over time to the same extent as remission rates raises questions about the effectiveness of services as currently delivered in achieving improved recovery”, added Dr Lally. 
 
Dr Lally and colleagues will now explore why recovery rates have not improved over the past twenty years compared to the previous twenty years.  They will conduct a review and meta-analysis of social outcomes and re-hospitalisation rates for people with first-episode psychosis, to begin to provide a comprehensive description of recovery related outcomes and ones which are important to patients and their families.
 
The paper, Remission and recovery from first-episode psychosis in adults: systematic review and meta-analysis of long-term outcome studies, is published in the December edition of the British Journal of Psychiatry and can be read here