title: Prediction of functional remission in first-episode psychosis: 12-month follow-up of the randomized-controlled trial on extended early intervention in Hong Kong.
abstract: BACKGROUND
  Functional remission (FR) is an intermediate and necessary step toward recovery, but is understudied in first-episode psychosis (FEP). We aimed to examine the rate and predictors of FR in FEP patients in the context of a randomized-controlled trial (RCT) comparing a 1-year extension of early intervention (Extended EI, 3-year EI) with step-down psychiatric care (SC, 2-year EI).
  
  
  METHODS
  One hundred sixty Chinese patients were recruited from a specialized EI program for FEP in Hong Kong after they have completed this 2-year EI service, randomly allocated to Extended EI or SC, and followed up for 12 months. Assessments on premorbid adjustment and personality, clinical profiles, functioning, and treatment characteristics were conducted. FR was operationalized as simultaneous fulfillment of attaining adequate functional levels (measured by Social and Occupational Functioning Scale and Role Functioning Scale) and competitive employment at 6 and 12 months. Data analysis was based on 156 subjects who completed follow-up functional assessments.
  
  
  RESULTS
  Thirty-one (19.9%) patients achieved FR status. Multivariate binary regression analysis showed that female gender, lower degrees of premorbid schizoid-schizotypal traits, Extended EI treatment condition, lower levels of positive symptoms at intake, and better baseline functioning independently predicted FR.
  
  
  CONCLUSIONS
  This is the first RCT providing supportive evidence to an extension of EI service beyond 2-year treatment duration on further enhancing the likelihood of FR attainment in FEP. Our findings that only approximately 20% of patients achieved FR indicate an unmet therapeutic need for promoting sustained adequate functional improvement in the early stage of psychotic illness.
authors.affiliation: Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong. Electronic address: changwc@hku.hk.
authors.forename: Wing Chung
authors.initials: WC
authors.lastname: Chang
authors.affiliation: Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: Vivian Wing Yan
authors.initials: VW
authors.lastname: Kwong
authors.affiliation: Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: Gloria Hoi Kei
authors.initials: GH
authors.lastname: Chan
authors.affiliation: Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: Olivia Tsz Ting
authors.initials: OT
authors.lastname: Jim
authors.affiliation: Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: Emily Sin Kei
authors.initials: ES
authors.lastname: Lau
authors.affiliation: Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: Christy Lai Ming
authors.initials: CL
authors.lastname: Hui
authors.affiliation: Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong.
authors.forename: Sherry Kit Wa
authors.initials: SK
authors.lastname: Chan
authors.affiliation: Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: Edwin Ho Ming
authors.initials: EH
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong.
authors.forename: Eric Yu Hai
authors.initials: EY
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D018479:Early Intervention, Educational / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D011618:Psychotic Disorders / Q000534:rehabilitation*; D012008:Recurrence; D012044:Regression Analysis; D016037:Single-Blind Method; D013997:Time Factors; D055815:Young Adult
keywords: Functional remission; extended early intervention; firstepisode psychosis; functional outcome; predictors