title: New evidence in support of staging approaches in schizophrenia: Differences in clinical profiles between first episode, early stage, and late stage.
abstract: Few studies have examined the progression of symptom dimensions in schizophrenia patients over the course of the illness. The objective of this study was to investigate whether clinical and psychopathological differences exist between first-episode schizophrenia (FES) and multiple-episode patients in an inpatient setting. Patients (N=203) were evaluated using the Positive and Negative Syndrome Scale (PANSS) over time. Five different generalized estimating equations were built for the PANSS factors using the following as covariates: sex, patient's age, assessment time point (i.e., moment of patient's evaluation, with a minimum of two and a maximum of four assessments throughout the study timeframe). The FES group was used as the reference to which the groups with up to five years of illness and more than five years of illness were compared. Remission rates and treatment resistance (TRS) rates were also compared. Generalized estimating equations were used to allow for different numbers of assessments over the study period. Patients with FES showed significantly milder severity in positive, disorganized, and hostility factors. Also, FES patients were more likely to achieve remission (P=0.002) and had lower rates of TRS (P=0.001). First-episode schizophrenia seems to be the critical period to improve outcome, as multiple-episode patients were similar in clinical characteristics regardless of illness duration.
authors.affiliation: Interdisciplinary Laboratory of Clinical Neurosciences (LiNC), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Schizophrenia Program (Proesq), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Department of Mental Health, Mogi das Cruzes School of Medicine (FMUMC)-Hospital das Clínicas Luzia de Pinho Melo-SPDM, Mogi das Cruzes, SP, Brazil. Electronic address: ortiz_bru@hotmail.com.
authors.forename: Bruno Bertolucci
authors.initials: BB
authors.lastname: Ortiz
authors.affiliation: Department of Mental Health, Mogi das Cruzes School of Medicine (FMUMC)-Hospital das Clínicas Luzia de Pinho Melo-SPDM, Mogi das Cruzes, SP, Brazil.
authors.forename: Fernanda Dal Medico
authors.initials: FD
authors.lastname: Eden
authors.affiliation: Department of Mental Health, Mogi das Cruzes School of Medicine (FMUMC)-Hospital das Clínicas Luzia de Pinho Melo-SPDM, Mogi das Cruzes, SP, Brazil.
authors.forename: Aline Silva Rodrigues
authors.initials: AS
authors.lastname: de Souza
authors.affiliation: Department of Mental Health, Mogi das Cruzes School of Medicine (FMUMC)-Hospital das Clínicas Luzia de Pinho Melo-SPDM, Mogi das Cruzes, SP, Brazil.
authors.forename: Carla Agostinho
authors.initials: CA
authors.lastname: Teciano
authors.affiliation: Department of Mental Health, Mogi das Cruzes School of Medicine (FMUMC)-Hospital das Clínicas Luzia de Pinho Melo-SPDM, Mogi das Cruzes, SP, Brazil.
authors.forename: Daniela Malatesta
authors.initials: DM
authors.lastname: de Lima
authors.affiliation: Interdisciplinary Laboratory of Clinical Neurosciences (LiNC), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Schizophrenia Program (Proesq), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Noto
authors.affiliation: Interdisciplinary Laboratory of Clinical Neurosciences (LiNC), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Schizophrenia Program (Proesq), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Cinthia Hiroko
authors.initials: CH
authors.lastname: Higuchi
authors.affiliation: Interdisciplinary Laboratory of Clinical Neurosciences (LiNC), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Hugo
authors.initials: H
authors.lastname: Cogo-Moreira
authors.affiliation: Interdisciplinary Laboratory of Clinical Neurosciences (LiNC), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Rodrigo Affonseca
authors.initials: RA
authors.lastname: Bressan
authors.affiliation: Interdisciplinary Laboratory of Clinical Neurosciences (LiNC), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Schizophrenia Program (Proesq), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Ary
authors.initials: A
authors.lastname: Gadelha
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012559:Schizophrenia / Q000175:diagnosis* / Q000628:therapy; D017211:Treatment Failure