Clinical outcomes in schizophrenia patients during first years of diagnosis, a cohort study

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Abstract

The first years after the diagnosis of schizophrenia are crucial for the establishment of parameters involved in the outcome and long-term remission. It is a risk period involving hazards like withdrawal from the general health system, relapses and suicide. This period also concurs with major challenges in development: stable identity, pair’s network, vocational training and intimate
relationships. Observational study of a cohort of 50 patients with a recent diagnosis of schizophrenia (within five years of baseline visit), followed up
during at least three years and up to five years, with periodic evaluations every three months. No changes were made in therapeutic schemes. This registry has the objective to describe the clinical outcomes in this particular group of patients: relapses, total or partial hospitalizations, days free of symptoms; and to suggest possible factors related to that evolution. Diagnosis was confirmed with M.I.N.I. interview, we employed short instruments including Clinical Global Impression – CGI, Global Assessment of Functioning – GAF, and Personal and Social Performance Scale – PSP. Most patients were men, single with secondary school grades.80% of patients experienced prodromal symptoms with a median
duration of 426 days (interquartile range – IR 90– 914), patients expended a median of 423 days since the beginning of psychotic symptoms (IR 77–823),
before the schizophrenia diagnosis were made. Before entering to the cohort, the patients had experienced a median of 2 psychotic episodes (IR 2–4), and 2 psychiatric hospitalizations (IR 2–4). The rate of substance use observed was 36% (Graphic 1). Most patients (96%) were treated with atypical antipsychotic, 16% were in treatment with depot medication, 64% of patients were receiving
concomitant medications, and only 8% of patients were receiving non-pharmacological treatment. Satisfaction with medication was negative in 10%,
neutral in 20% and positive in most patients (70%). Adherence was described by patient and relatives as high (mean 89%). At the end of the first year, the
proportion slightly changed, turning negative in 15%, neutral in 22%, and positive in 63%; Meanwhile the adherence described continued high (mean 84%).
Most patients were followed for at least three years, here we describe the relapse and survival rate. There were a higher proportion of males, which could not
reflect exactly the whole spectrum of this population. It is noticeable the long period of time the patient spends with prodromal and psychotic symptoms before the diagnosis was made, especially regarding the known impact of the duration of untreated psychosis in the outcome of patients. There is a strong association between schizophrenia and cannabis, the rate of substance use observed in our cohort was 36%, higher than general population and like previous descriptions on literature. Most patients with schizophrenia will have at least one relapse within the first five years.
Translated title of the contributionDesenlaces clínicos en esquizofrenia en pacientes durante los primeros años del diagnóstico, un estudio de cohorte
Original languageEnglish (US)
StatePublished - May 5 2018
EventAmerican Psychiatric Association (APA) 171st Annual Meeting - Jacob K. Javits Convention Center, Nueva York, United States
Duration: May 5 2018May 9 2018
Conference number: P1-070

Conference

ConferenceAmerican Psychiatric Association (APA) 171st Annual Meeting
Abbreviated titleAPA
CountryUnited States
CityNueva York
Period5/5/185/9/18

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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