Symptomatic and functional recovery from a first episode of schizophrenia or schizoaffective disorder.
OBJECTIVE
Follow-up studies have found that a substantial number of patients with schizophrenia achieve full recovery (i.e., sustained improvement in both symptoms and social/vocational functioning) when examined decades after an index admission. This study addressed recovery during the crucial early course of the illness.


METHODS
Subjects in their first episode of schizophrenia or schizoaffective disorder (N=118) were assessed at baseline and then treated according to a medication algorithm. Full recovery required concurrent remission of positive and negative symptoms and adequate social/vocational functioning (fulfillment of age-appropriate role expectations, performance of daily living tasks without supervision, and engagement in social interactions).


RESULTS
After 5 years, 47.2% (95% CI=36.0%-58.4%) of the subjects achieved symptom remission, and 25.5% (95% CI=16.1%-34.7%) had adequate social functioning for 2 years or more. Only 13.7% (95% CI=6.4%-20.9%) of subjects met full recovery criteria for 2 years or longer. Better cognitive functioning at stabilization was associated with full recovery, adequate social/vocational functioning, and symptom remission. Shorter duration of psychosis before study entry predicted both full recovery and symptom remission. More cerebral asymmetry was associated with full recovery and adequate social/vocational functioning; a schizoaffective diagnosis predicted symptom remission.


CONCLUSIONS
Although some patients with first-episode schizophrenia can achieve sustained symptomatic and functional recovery, the overall rate of recovery during the early years of the illness is low.
Department of Psychiatry Research, the Zucker Hillside Hospital, Glen Oaks, NY 11004, USA. robinson@lij.edu
Delbert G
DG
Robinson
Margaret G
MG
Woerner
Marjorie
M
McMeniman
Alan
A
Mendelowitz
Robert M
RM
Bilder
D000203:Activities of Daily Living / Q000145:classification / Q000523:psychology; D000465:Algorithms; D001921:Brain / Q000187:drug effects / Q000473:pathology; D003131:Combined Modality Therapy; D004292:Dominance, Cerebral / Q000187:drug effects / Q000502:physiology; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D009518:New York; D010343:Patient Admission; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D012050:Rehabilitation, Vocational; D012559:Schizophrenia / Q000175:diagnosis / Q000534:rehabilitation*; D012565:Schizophrenic Psychology; D012917:Social Adjustment