Long-term trajectories of positive and negative symptoms in first episode psychosis: A 10year follow-up study in the OPUS cohort.
OBJECTIVE
Knowledge about course of illness can help clinicians to develop effective interventions and improve treatment outcomes. The goal of this study was to construct positive and negative symptom trajectories based on structured clinical assessments collected over 10years within a cohort of people with first episode psychosis.


METHODS
A cohort of 496 people with first episode psychosis (ICD-10, F20-28) originally recruited for the OPUS study (1998-2000) and treated in community psychiatric services were rated on clinical symptoms at 5 different occasions across ten years. Psychopathology was assessed using the Scales for Assessment of Positive and Negative Symptoms. Symptom trajectories were constructed using Latent Class Analysis.


RESULTS
Five distinct trajectories were identified for positive symptoms (response - 47%, delayed response - 12%, relapse - 15%, non-response - 13% and episodic response - 13%). Four distinct trajectories were identified for negative symptoms (response - 28%, delayed response - 19%, relapse - 26% and non-response - 27%). Multivariable regression analysis of baseline characteristics identified that longer duration of untreated psychosis (OR 1.27-1.47, p<0.05) and substance abuse (OR 3.47-5.90, p<0.01) were associated with poorer positive symptom trajectories (higher levels of psychotic symptoms) while poor social functioning (OR 1.34-5.55, p<0.05), disorganized symptoms (OR 2.01-2.38, p<0.05) and schizophrenia diagnosis (OR 5.70-8.86, p<0.05) were associated with poorer negative symptom trajectories (higher levels of negative symptoms). A proportion of people displayed significant changes in symptoms several years after diagnosis.


CONCLUSIONS
Trajectories of illness for positive and negative symptoms were heterogeneous among people with first episode psychosis. Positive symptoms showed a general pattern of reduction and stabilization over time while negative symptoms typically showed less variation over the ten years. Results have implications for the focus, timing and length of interventions in first episode psychosis.
Centre for Psychiatric Research, Aarhus University, Aarhus, Denmark; Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark. Electronic address: stephen.01.austin@regionh.dk.
Stephen F
SF
Austin
Centre for Psychiatric Research, Aarhus University, Aarhus, Denmark.
Ole
O
Mors
Biostatistics Department, University of Copenhagen, Copenhagen, Denmark.
Esben
E
Budtz-Jørgensen
Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark.
Rikke Gry
RG
Secher
Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark.
Carsten R
CR
Hjorthøj
Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark.
Mette
M
Bertelsen
Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark.
Pia
P
Jeppesen
Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark.
Lone
L
Petersen
Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark.
Anne
A
Thorup
Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark.
Merete
M
Nordentoft
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000503:physiopathology* / Q000523:psychology*; D055815:Young Adult
Course of illness; Schizophrenia; Symptom trajectories