Insidious Symptom Onset Predicts Poorer Outcome in Schizophrenia

One of the first signs of schizophrenia is a psychotic episode. Symptoms of psychosis can appear weeks, months, or even years before a psychotic episode requiring medical attention. Because psychotic symptoms can appear suddenly or more subtly, the duration of untreated psychosis (DUP) varies from individual to individual. Likewise, the acute onset or subtle onset of symptoms can also impact whether symptoms become severe (SC) or persist as less severe (NonSC). Schizophrenia can be difficult to treat, but many people who receive care for symptoms are able to achieve remission within the first few months. However, relapse is not uncommon and estimates point to a nearly 75% relapse rate within the first five years of treatment.

Nobuhiso Kanahara of the Department of Psychiatry at the Graduate School of Medicine at Chiba University in Japan wanted to explore how symptom severity, DUP, and mode of onset (MoO) of symptoms, either subtle or acute, affect long-term illness prognosis. To do this, Kanahara conducted a 10-year study involving several hundred participants treated for psychosis at a psychiatric hospital. The participants were assessed at initial intake for symptom severity, MoO and DUP. These factors were evaluated and measured against treatment outcomes and future diagnoses of schizophrenia.

The results revealed that although the DUP did not differ significantly between participants with SC and NonSC participants, those with acute onset had much shorter DUPs than those with more subtle MoOs. Further, those with subtle MoO, although they did not have more severe symptoms than acute MoO participants, did have poorer overall global functioning in the long-term. In other words, the subtle MoO participants had both longer DUPs and poorer illness prognoses than those with acute MoO.

Kanahara believes that acute and sudden psychosis can lead to more prompt medical attention and therefore, better treatment outcome. Individuals with more insidious MoO, on the other hand, may have symptoms that go unnoticed for a long period of time. In fact, in this study, the DUP for MoO was over three years at its longest, suggesting a chronic psychotic state than can lead to poorer overall outcomes.

Kanahara said, “Taken together, these results indicate that the initial positive symptoms do not act definitively as a prognosis predictor.” However, DUP and MoO appear to be strong indicators of overall illness outcome and therefore, should be examined more closely in clinical assessments and trials.

Reference:
Kanahara, N., Yoshida, T., Oda, Y., Yamanaka, H., Moriyama, T., et al. (2013). Onset pattern and long-term prognosis in schizophrenia: 10-year longitudinal follow-up study. PLoS ONE 8(6): e67273. doi:10.1371/journal.pone.0067273

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