Symptomatic and Functional Recovery From a First Episode of Schizophrenia or Schizoaffective Disorder

TLDR

Long‑term follow‑up studies show that many schizophrenia patients eventually achieve full recovery. The study examined recovery during the early course of first‑episode schizophrenia or schizoaffective disorder. A cohort of 118 first‑episode patients was assessed at baseline and treated with a medication algorithm, with full recovery defined as concurrent remission of positive and negative symptoms plus adequate social/vocational functioning. After five years, 47 % achieved symptom remission, 25 % had adequate social functioning, and only 14 % met full recovery criteria; better cognition, shorter psychosis duration, cerebral asymmetry, and schizoaffective diagnosis were associated with recovery outcomes.

Abstract

OBJECTIVE: Follow-up studies have found that a substantial number of patients with schizophrenia achieve full recovery (i.e., sustained improvement in both symptoms and social/vocational functioning) when examined decades after an index admission. This study addressed recovery during the crucial early course of the illness. METHOD: Subjects in their first episode of schizophrenia or schizoaffective disorder (N=118) were assessed at baseline and then treated according to a medication algorithm. Full recovery required concurrent remission of positive and negative symptoms and adequate social/vocational functioning (fulfillment of age-appropriate role expectations, performance of daily living tasks without supervision, and engagement in social interactions). RESULTS: After 5 years, 47.2% (95% CI=36.0%–58.4%) of the subjects achieved symptom remission, and 25.5% (95% CI=16.1%–34.7%) had adequate social functioning for 2 years or more. Only 13.7% (95% CI=6.4%–20.9%) of subjects met full recovery criteria for 2 years or longer. Better cognitive functioning at stabilization was associated with full recovery, adequate social/vocational functioning, and symptom remission. Shorter duration of psychosis before study entry predicted both full recovery and symptom remission. More cerebral asymmetry was associated with full recovery and adequate social/vocational functioning; a schizoaffective diagnosis predicted symptom remission. CONCLUSIONS: Although some patients with first-episode schizophrenia can achieve sustained symptomatic and functional recovery, the overall rate of recovery during the early years of the illness is low.