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Study points to more positive outlook for people with psychosis than previously thought

New King's College London research, published in the British Journal of Psychiatry, indicates a more positive outlook for people diagnosed with first episode psychosis (FEP) and first episode schizophrenia (FES) than has been suggested by previous studies.

Researchers from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London and the South London and Maudsley NHS Foundation Trust conducted the first meta-analysis of remission and recovery rates in FEP. The study found that 58 per cent of patients with FEP met the criteria for remission, whilst 38 per cent met the criteria for recovery over mean follow up periods of 5.5 years and 7.2 years respectively. This is higher than previously identified rates of 40 per cent for remission and just 13.5 per cent for recovery.

In addition, the study identified a recovery rate of 30 per cent for those with FES, a much more encouraging outcome than the one in seven with functional recovery in schizophrenia identified in a 2012 meta-analysis.

One of the reasons behind this difference in remission and recovery rates is that previous studies conducted included people with both first episode and multi episode disorder. Multi episode patients include those with more chronic or treatment resistant illnesses, who would by definition be expected to have lower recovery rates.

Dr John Lally from King's College London said: ‘This is the first meta-analysis of remission and recovery rates focusing solely on people with a first episode of psychosis and/or schizophrenia. We wanted to see if the low rate of remission and recovery identified in previous studies was consistent for people from the first episode of psychosis or schizophrenia. What we’ve found is evidence to suggest that a progressive deteriorating course of illness is not an inherent part of illness course for all. However, while remission rates have improved over time, recovery rates have not during the same time period. This raises questions about the effectiveness of specialist early intervention services in achieving improved recovery.’

Dr John Lally and his colleagues will now explore why recovery rates have not improved over the past twenty years. They will conduct a review and meta-analysis of social outcomes and re-hospitalisation rates for people with FEP, to begin to provide a comprehensive description of recovery related outcomes and ones which are important to patients and their families.

Paper reference: Lally, J et al (2017) Remission and recovery from first-episode psychosis in adults: A systematic review and meta-analysis of long term outcome studies British Journal of Psychiatry