David Baxter PhD
Late Founder
Critical period of illness confirmed in early schizophrenia
By Andrew Czyzewski
06 January 2009
Br J Psychiatry 2009; 194: 18?24
Patients with schizophrenia experience a critical period of illness 4-5 years after the onset of symptoms, during which time they deteriorate rapidly and then stabilize or improve slightly, study results show.
Furthermore, duration of untreated illness predicted the extent of recovery after the critical period, Eadbhard O?Callaghan (DELTA/DETECT Early Intervention in Psychosis Services, Dublin, Ireland) and colleagues report in the British Journal of Psychiatry.
The critical period hypothesis proposes that in the early phase of psychosis, including any period of initially untreated psychosis, symptomatic and psychosocial deterioration progresses rapidly.
Afterwards, progression of morbidity slows or stops, and the level of disability sustained, or recovery attained, by the end of the critical period endures into the long term.
?This hypothesis has underpinned the development of services specialising in early intervention in psychosis in the UK and elsewhere, but some have argued that services dedicated to early intervention ?for an arbitrary ?critical period? of a few years? waste scarce resources,? O?Callaghan and team note.
The researchers therefore followed-up 118 people consecutively referred with a first-episode of psychosis in southeast Dublin between 1995 and 1999.
After 4 years of follow-up, 29 (43.3%) patients were in remission, while after 8 years 33 (49.3%) were in remission ? a nonsignificant difference.
Between 4 and 8 years, negative symptoms scores of patients improved on average from 16.6 to 13.4 out of a possible 62, as did disorganised symptoms from 16.9 to 15.3 out of a maximum of 70.
Meanwhile, positive symptoms and social functioning scores remained stable in this time period.
Crucially, patients with at least a 2-year duration of untreated illness were less likely to show functional recovery between 4 and 8 years than those with a shorter untreated period (odds ratio=0.4).
?These results provide qualified support for the critical period hypothesis,? O?Callaghan and colleagues assert.
However, they caution that a long duration of untreated psychosis could actually be a proxy for insidious onset or some other unmodifiable determinant of outcome.
?Ultimately, this question will be answered by long-term randomized controlled trials of early intervention.
?While we await such trials, we cautiously propose that our findings show that a shorter duration of untreated psychosis brings with it benefits that extend well beyond the critical period.?
Abstract
By Andrew Czyzewski
06 January 2009
Br J Psychiatry 2009; 194: 18?24
Patients with schizophrenia experience a critical period of illness 4-5 years after the onset of symptoms, during which time they deteriorate rapidly and then stabilize or improve slightly, study results show.
Furthermore, duration of untreated illness predicted the extent of recovery after the critical period, Eadbhard O?Callaghan (DELTA/DETECT Early Intervention in Psychosis Services, Dublin, Ireland) and colleagues report in the British Journal of Psychiatry.
The critical period hypothesis proposes that in the early phase of psychosis, including any period of initially untreated psychosis, symptomatic and psychosocial deterioration progresses rapidly.
Afterwards, progression of morbidity slows or stops, and the level of disability sustained, or recovery attained, by the end of the critical period endures into the long term.
?This hypothesis has underpinned the development of services specialising in early intervention in psychosis in the UK and elsewhere, but some have argued that services dedicated to early intervention ?for an arbitrary ?critical period? of a few years? waste scarce resources,? O?Callaghan and team note.
The researchers therefore followed-up 118 people consecutively referred with a first-episode of psychosis in southeast Dublin between 1995 and 1999.
After 4 years of follow-up, 29 (43.3%) patients were in remission, while after 8 years 33 (49.3%) were in remission ? a nonsignificant difference.
Between 4 and 8 years, negative symptoms scores of patients improved on average from 16.6 to 13.4 out of a possible 62, as did disorganised symptoms from 16.9 to 15.3 out of a maximum of 70.
Meanwhile, positive symptoms and social functioning scores remained stable in this time period.
Crucially, patients with at least a 2-year duration of untreated illness were less likely to show functional recovery between 4 and 8 years than those with a shorter untreated period (odds ratio=0.4).
?These results provide qualified support for the critical period hypothesis,? O?Callaghan and colleagues assert.
However, they caution that a long duration of untreated psychosis could actually be a proxy for insidious onset or some other unmodifiable determinant of outcome.
?Ultimately, this question will be answered by long-term randomized controlled trials of early intervention.
?While we await such trials, we cautiously propose that our findings show that a shorter duration of untreated psychosis brings with it benefits that extend well beyond the critical period.?
Abstract
