Symptom Remission and Functional Outcomes in Patients with Recent-Onset Schizophrenia: A One-Year Prospective Observational Study

Chung, Seockhoon; Bahk, Won Myong; Kwon, Jun Soo; Park, Ji Hong; Ahn, Joon Ho; Goh, Jinkyung; Kim, Chang Yoon

Abstract

OBJECTIVES
The long-term outcome of schizophrenia is still considered variable and inconclusive. We performed a one-year prospective observational study to investigate the longitudinal outcomes in patients with recent-onset schizophrenia. The primary purpose was to determine the descriptive outcomes in terms of symptom remission and psychosocial function. The secondary purpose was to identify predictor variables associated with the outcomes.
METHODS
Patients experiencing their first episode of psychosis or hospitalization within the past 2 years with a diagnosis of DSM-IV schizophrenia were included. Clinical symptoms were assessed monthly using Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS) and Clinical Global Impression (CGI) scale. Psychosocial function was measured using PSYCH-UP (Psychosocial symptoms you currently have, follow-up version) and Heinrichs' Quality of Life Scale (QLS) at baseline, 6, and 12 months and Global Assessment of Functioning (GAF) monthly. Remission was defined on the basis of overall, and psychotic core symptoms as having 1) BPRS total score < or =36, and 2) Each individual item score of core psychotic items (conceptual disorganization, suspiciousness, hallucinatory behavior, unusual thought content) < or =3, and 3) CGI severity score < or =3, and 4) Duration of remission at least for 2 consecutive months. To identify the predictive variables for the outcome, relationships between time to remission and various clinical variables were examined using Cox proportional hazards model.
RESULTS
A total of 49 patients with schizophrenia were enrolled in this study. The proportions of patients with symptom remission were 54.5% (24/44, drop outs=5) at 3 months, 55.3% (21/38, drop outs=11) at 6 months, and 64.3% (18/28, drop outs=21) at 12 months. Mean time to remission was 3.76+/-2.43 (s.d.) months, and the mean duration of remission was 7.54+/-2.99 months. Significantly longer time to remission was predicted by higher SANS total score at baseline in various predictor variables (p=0.01). Impairments of psychosocial function measured using PSYCH-UP and QOL were significantly improved at the end of this study, but still remained at mild to moderate level. SANS total score and GAF score significantly correlated with most of the items related to psychosocial function at 12 months. The proportion of the patients with GAF score > or =60 increased from 6.1% at baseline to 85.8% at 12 months. Of the patients who were in remission at 12 months, 95.5% obtained GAF score > or =60.
CONCLUSION
This study showed 64.3% of symptom remission rate in patients with recent-onset schizophrenia. Symptom remission was accompanied by significant improvement of global function. The severity of negative symptom at baseline appeared to be a significant predictor for time to remission. Psychosocial function was improved at the end of this study, but impairments still remained at mild to moderate level. GAF score and negative symptoms significantly correlated with psychosocial function.