New Review Suggests Higher Recovery and Remission Rates for Psychosis

Meta-analysis gives updated recovery and remission rates for persons identified as having a first-episode psychosis and those diagnosed with schizophrenia

Bernalyn Ruiz
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Researchers from King’s College London conducted a systematic review and meta-analysis to provide improved rates of recovery and remission for persons identified as having a first-episode psychosis (FEP) and those diagnosed with schizophrenia. The overall rates of both remission and recovery found in this meta-analysis are significantly higher than those reported in previous studies.

Previously, rates of remission and recovery for people with first-episode psychosis were estimated to be 40% and 13.5%, respectively. However, for methodological reasons, the findings remain uncertain. The authors of the present review and meta-analysis point out that, unfortunately, these findings do not provide a clear picture because earlier studies did not include outcomes at follow up and included both persons with first-episode and multi-episode psychoses. The authors explain that including individuals with first and multiple-episode confounds the results as patients reporting multiple-episodes are expected to have lower recovery rates.

Other reviews have found that 42% of patients diagnosed with FEP have ‘good outcomes’ compared to only 31% of those diagnosed with schizophrenia. What constitutes a good outcome, however, is uncertain as the threshold often differed for each study. The authors of this study highlight that the lack of clarity concerning recovery and remission rates within this population is, in part, due to the numerous outcome definitions that are used. This inconsistency makes it problematic to compare outcomes across studies.

This study aimed to improve the field’s knowledge concerning rates of recovery and remission for individuals diagnosed with first episode psychosis and schizophrenia. To accomplish this task, the authors conducted a systematic review and meta-analysis, compiling data on prevalence rates of remission and recovery in FEP while also exploring factors that may influence these outcomes.

To address the issue of having numerous definitions of remission and recovery, the authors utilized the definition established by the Remission in Schizophrenia Working Group (RSWG). This definition of remission includes having both symptomatic and/or functional improvement and at least six months with only mild symptoms or no symptoms at all. Recovery, in this study, was defined as at least two years of symptomatic and functional improvement across social, occupational, and educational domains. Seventy-nine studies were included in the review.

The results of the meta-analysis were as follows:

Remission

  • Rate of remission was 58% (pooled data for 19,072 individuals form the studies included in the meta-analysis)
  • For studies that only included people with schizophrenia, rate of remission was 56%
  • Remission rates were higher in the affective psychosis group (79%)
  • Remission rates were significantly higher in studies from Africa (73%), Asia (66%) and North America (65%) compared to other regions included in the review
  • In the most recent study period (2005-2016), studies from North America (70%), Asia (69%), and Africa (63%) had increased remission rates, compared to European studies (45%)

Recovery

  • Prevalence of recovery was found to be 38% (from data of 9,642 individuals)
  • Equivalent rates of recovery were found in those with FEP (34%) and schizophrenia (30%)
  • Prevalence of recovery was significantly higher in North America (71%) than in Europe (21%), Asia (35%), and Australia (28%)
  • In the most recent study period, recovery rates significantly increased in North America (86%) compared with Europe (21%) and Asia (41%)

Moderators

  • Higher remission rates were associated with studies conducted in more recent years
  • Higher rates of recovery were moderated by White ethnicity
  • Lower rates of recovery were moderated by Asian ethnicity

Overall, this study sheds light on recovery and remission rates in individuals who were identified as experiencing FEP and those diagnosed with schizophrenia. At a mean 5.5 years of follow-up, 58% of persons with FEP experienced remission, while 38% of persons with schizophrenia achieved remission at a mean of 7.2 years. The authors point out that the finding that 58% of individuals with FEP met criteria for recovery stands in stark contrast to the previously estimated rate of 13%.

Lastly, the authors draw attention to the finding that the pooled recovery rate for studies conducted between 1997 and 2016 (32%) is lower than the rate for studies conducted from 1976 to 1996 (45%). As a result, these findings may raise questions about the effectiveness of specialized early intervention clinics for psychosis that have proliferated in recent years. The researchers write that this finding “indicates that thus far the dedicated specialist care provided for patients with FEP over the past two decades has not resulted in improved recovery rates.”

 

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Lally, J., Ajnakina, O., Stubbs, B., Cullinane, M., Murphy, K. C., Gaughran, F., & Murray, R. M. (2017). Remission and recovery from first-episode psychosis in adults: systematic review and meta-analysis of long-term outcome studies. The British Journal of Psychiatry, bjp-bp. (Link)

13 COMMENTS

    • Also ‘draw’ should be in past tense ‘drew’. ‘Form’ –>’from’.

      Although it sounds much like institutional babble I see why some research articles in Clinical Psychology reads like articles in Epidemiology where treatments are dispensed impersonally in units. I am not bothered at all by this lack of human warmth on large scale prognosis study. Although I think one might have a disdain to such an attitude to psychotherapy. Time is a limited resource. Reality itself constrains. Same for DSM. I do not want to mock this style of writing because it is necessary and fully reflects the realities of our lives. The typical patient would be a young mom who is married to a husband who brings only a modest income so she cannot afford a boutique psychotherapist which is why she receives her care from a publicly funded program. She fills out a ridiculously worded likert scale both at the beginning and at the end of her course of treatment. But the #1 matter to her is how much is the therapy. That is 99% of us.

      I recall the Essay by George Orwell the politics of English Language and some might argue the way many scholarly articles are written as evidence of the whole institution of clinical psychology is corrupt and dehumanizing, which is far from the truth. This is reality. The language of human warmth and authenticity that is pretending to be your mother or lover is deceptive and possibly manipulative.

    • I believe “Schizophrenia” became “chronic” in the 1990s – the idea was people did not recover. Present day descriptions usually describe “Schizophrenia” as a long term seriois and chronic condition.

      In the 1980s I believe people were expected to move back into life. This is where (with me) the drug side effects became an issue.

      These days “Schizophrenia” disability is soaking up billions, and the atypicals are out of patent. But I would believe that the drug side effects are still the the main disability issue.

      The other side of things is that so many other people are now in the “Severe Mental Illness” categorization bracket, and on strong neuroleptics. These people would also be genuinely Disabled.

      • To claim “Mental Health” Disability Benefit I believe a person has got to persuade the Benefit People that they are still suffering from Mental Illness Symptoms.

        But with me (and probably most of the other people) it was the very real “medication” side effects that had me “immobilised”.

        Basically I believe the Recovery/Disability Research Starting off points are one of misinformation:-
        – i.e. in “Mental Health” (unfortunately) it is often policy to Deny drug side effects exist.

  1. “Psychosis” and “schizophrenia” are untestable and imprecise terms or theories. Today’s American “mental health professionals,” in their own words, believe all thoughts, gut instincts, and dream queries are “psychosis,” which are proof of a “lifetime, incurable, genetic mental illness.”

    This definition of “psychosis” is absurd, since it means everyone who dreams or thinks is “psychotic.” And there is zero scientific proof that any of the “psychotic” DSM disorders, including “schizophrenia” and “bipolar,” are illnesses with a genetic etiology.

    But there is medical evidence that today’s treatments for “psychosis” and “schizophrenia,” the antipsychotic (aka neuroleptic) drugs, can all by themselves create both the negative and positive symptoms of “schizophrenia.” Which would imply that most so called “schizophrenia,” and the other “psychotic” disorders, likely have primarily an iatrogenic, as opposed to genetic, etiology.

    The negative symptoms of “schizophrenia” can be created via neuroleptic induced deficit syndrome and the positive symptoms of “schizophrenia,” including “psychosis,” can be create via antidepressant and/or antipsychotic induced anticholinergic toxidrome.

    https://en.wikipedia.org/wiki/Neuroleptic-Induced_Deficit_Syndrome
    https://en.wikipedia.org/wiki/Toxidrome

    But since neither of these neuroleptic induced syndrome are listed in the scientifically invalid DSM, they are always misdiagnosed as one of the billable DSM disorders.

    It is highly likely the best way to see recovery in those labeled as “psychotic” or “schizophrenic” is to wean them off the neuroleptic drugs, which actually create these symptoms. Although, withdrawal from this drug class can also create “psychosis.” So the best way to see recovery in those labeled as “psychotic” or “schizophrenic” is to get the psychiatrists to stop putting people on the neuroleptics in the first place.

    • The staggering use of anti-depressants began in the early 1980’s. They were in use previously, since the 1950’s, but in the 80’s the drug companies aligned with the “mental health” industry to push them through marketing. Prozac came along in 1987 and was marketed as a “miracle cure” for depression which didn’t work out that way. Yet, the FDA has turned over every time a new psychiatric med has hit the market though decades have shown no efficacy and a host of concerns.

  2. WHAT ABOUT THE PSYCHOLOGICAL CURE?

    I’ve got 30 + years of recordable Wellness and non disability, as a result of carefully not taking my “medication” in 1984, and moving to “Psychology”.

    I was diagnosed as chronically “Sxxxx “/ “Sxxx Axxxx” and registered disabled between 1980 and 1984. I can also explain how, and why I recovered.

    I was originally “hospitalized” at the Maudsley/Kings College in 1980 and have offered an Account of my Recovery – but was refused.

    My GP Surgery in Central London is also behaving like a Wanker*.
    *
    http://gawker.com/5937351/irish-president-unloads-on-wanker-tea-party-radio-host

  3. RECORDABLE WELLNESS, AND ITS ATTEMPTED DENIAL

    EMAIL FROM : ME

    TO: MY GP SURGERY, NEWTON MEDICAL CENTRE (Central London)

    DATE: December 12 2017 at 15:12

    Dear Manager Ruth Sandu, Dr Simons,

    Regarding:- Representative Medical Records

    I believe that If my Medical History is represented fairly and accurately, on my Medical Records, that there is nothing in this history that I would need to be too concerned about.

    ICO
    I have been in contact with the UK Information Commissioners Office, and my understanding is:-

    1. That I can amend factually incorrect information on my Medical Records.

    2. That I can enter “my own commentary” by way of “notes” to my Medical Records.

    I WOULD LIKE TO BEGIN THIS PROCESS

    REQUESTING
    Would you please acknowledge and describe the attachments that I have listed below and please inform me of their location on your information system.

    WHY
    The information in these attachments is relevant to the fair and accurate representation of my Medical History.

    ATTACHMENTS 1
    Attached to an Email Sent to Newton Medical on April 27 2017 at 11:20

    1. The Relevant Sections of my November 8, 1986 Handwritten Adverse Drug Reaction Warning Request Letter (3 pages).

    2. The November 24, 1986 Irish Record Summary (2 pages) – With Requested Adverse Drug Reaction Warning Intentionally OMITTED.

    3. My January 13, 2012 ‘Near Fatal Modecate Experience’ – ‘Statement’, sent to;- Galway University, Depot Side Effect Research & Monitoring Team

    4. Admitting Doctor, Dr Fadels description of me ‘on presentation’ at Galway in November 1980.

    5. The November 1986 False Reassurance Letter From Dr Donlon Kenny

    ATTACHMENTS 2
    Attached to an Email sent Newton Medical on September 18 2017 at 11:27

    1. A character reference from Ireland from 1986

    2. An employer’s reference from Ireland 1986

    3. A Subcontractors Inland Revenue ID Card from 1997

    4. A House of Commons Subcontractors ID Card from 2003

    5. A Construction Skills Certification Scheme ID Card from 2003

    6. A Construction Skills Certification Scheme ID Card from 2008

    7. A Construction Skills Certification Scheme ID Card from 2016

    8. CSCS ID Card 2008 Reverse Side

    9. CSCS ID Card 2016 Reverse Side

    Would you please acknowledge this
    communication, and get back to me about it.

    Thank you for your help.

    Yours Sincerely

    ME

    (SO FAR – I HAVE HAD NO REPLY)

  4. Is this TAU Treatment as usual?
    It would be interesting to look at spread and the results of different treatment protocols.
    Robert Whitaker talks about the Open Dialogue model in Finland. This program gets 80% recovery rates from what would have normally been called, “Schizophrenia.” They delay the initial use of medications and diagnoses and instead address the needs for family and social supports. Recorded by Corinna West at the 2011 SAMHSA Pharmacology Dialouge
    https://www.youtube.com/watch?v=5wELX6xaRVc