title: Prodromal symptoms and remission following first episode psychosis.
abstract: BACKGROUND
  Describing the trajectory of prodromal symptoms has obvious appeal in supporting advances towards sub-clinical intervention. Identifying clinical phenomena associated with unfavourable illness outcomes could have greater significance in explaining some heterogeneity within and between psychotic disorders and advancing understanding of pre-psychotic typologies. Few studies have assessed the continuity, if any, between prodromal phases and illness outcome one year after treatment.
  
  
  METHODS
  We assessed 375 people with first-episode psychosis (FEP) and 215 (57.4%) were seen approximately one year later. We performed factor analysis on prodromal symptom items obtained by interview with families and participants and identified a five-factor solution. We determined whether these factors predicted non-remission from psychosis in the presence of other factors that may predict outcome including premorbid adjustment, duration of prodrome and untreated psychosis (DUP), baseline symptoms and DSM-IV diagnoses. We used random forest classification to predict the most important variables and logistic regression to identify specific predictors.
  
  
  RESULTS
  We identified five prodromal symptom factors comprising Negative Symptoms, General Psychopathology, Reality Distortion, Strange Ideas and Irritability. Prodromal symptoms did not predict a greater risk of non-remission with the exception of Irritability and this factor was also associated with earlier age at onset, being male and a diagnosis of substance-induced psychosis. Being male, DUP and baseline positive symptoms predicted non-remission at one year.
  
  
  CONCLUSIONS
  Prodromal symptoms were not linked with outcome after a year of treatment which could be explained by greater heterogeneity in illness psychopathology which may be more pronounced in broad FEP diagnoses at different stages. It could also be explained by prodromal symptoms exerting greater influence earlier in the course illness.
authors.affiliation: School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK. Electronic address: laoiserenwick@gmail.com.
authors.forename: Laoise
authors.initials: L
authors.lastname: Renwick
authors.affiliation: DETECT Early Psychosis Service, Dublin, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Lyne
authors.affiliation: DETECT Early Psychosis Service, Dublin, Ireland; Orygen, The National Centre for Excellence in Youth Mental Health, Melbourne, Australia.
authors.forename: Brian O
authors.initials: BO
authors.lastname: Donoghue
authors.affiliation: DETECT Early Psychosis Service, Dublin, Ireland.
authors.forename: Liz
authors.initials: L
authors.lastname: Owens
authors.affiliation: DETECT Early Psychosis Service, Dublin, Ireland.
authors.forename: Roisin
authors.initials: R
authors.lastname: Doyle
authors.affiliation: Cork University Hospital, Cork, Ireland.
authors.forename: Michele
authors.initials: M
authors.lastname: Hill
authors.affiliation: St. John of God Hospital, Dublin, Ireland; School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland.
authors.forename: Emma
authors.initials: E
authors.lastname: McCarthy
authors.affiliation: School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Pilling
authors.affiliation: School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK.
authors.forename: Eadbhard
authors.initials: E
authors.lastname: O'Callaghan
authors.affiliation: DETECT Early Psychosis Service, Dublin, Ireland; St. John of God Hospital, Dublin, Ireland; Department of Psychiatry, University College Dublin, Dublin, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: Clarke
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D025341:Principal Component Analysis; D062706:Prodromal Symptoms; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000503:physiopathology*; D012189:Retrospective Studies
keywords: Duration of prodrome; Duration of untreated psychosis; First-episode psychosis; Prodromal symptoms