Can we predict the future of patients with early-episode psychosis?

The ability to better predict patient outcomes would be highly valuable to clinicians, allowing the selection and tailoring of the most appropriate antipsychotic treatment for individual patients. The state of the art of outcome prediction for patients with first-episode psychosis was reviewed at EPA Virtual 2021.

The outcome of first-episode psychosis (FEP) varies and several baseline measures may predict that outcome, explained Professor Maija Lindgren, Finnish Institute for Health and Welfare, Finland, in her presentation at EPA 2021. Identifying outcomes for individual patients could affect treatment choice and improve outcome.

Professor Lindgren summarized where we are, showing data from the Helsinki Early Psychosis Study conducted in young adults (aged 18-41 years) with FEP. Currently, we do have some markers, albeit with limited prognostic value.

  • Better cognitive function at the start of treatment is associated with improved positive and affective symptoms at one year follow-up, but is not associated with improved negative symptoms.1

Early anxiety and depression may be a normal reaction to illness onset

  • Severe symptoms of obsessive compulsive disorder are predictive of a lower rate of remission, whereas a high level of anxiety is associated with better functioning at one year follow-up.2
  • Higher levels of anxiety and depression at baseline also predict better cognitive outcomes in the early stage of illness, but not one year later. Professor Lindgren hypothesized that this interesting observation could be because anxiety and depression are part of a normal reaction to illness onset and so a marker of intact cognitive performance.3

 

Increased metabolic risk for patients with psychotic disorders

Patients with first episode psychosis were found to be around 10 kg heavier after one year

Patients with psychotic disorders are at increased risk of obesity, cardiovascular disease and diabetes.

Patients with FEP were found to be around 10 kg heavier after one year in a study conducted to identify markers of weight gain. After adjusting for the use of a second-generation antipsychotic, early insulin resistance was a predictor of weight gain, particularly waist circumference, reported Professor Lindgren.4

Insulin resistance may be a valuable marker of vulnerability to weight gain and abdominal obesity for patients with first episode psychosis

 

C-reactive protein is a marker of metabolic risk in early psychosis

In another study, C-reactive protein – a marker of inflammation and cardiovascular risk – was 2.5% higher in the year after the first episode of psychosis. This was strongly associated with female gender and waist circumference, providing further evidence for increased metabolic risk in this vulnerable population with FEP.5

“We still don’t know enough and there’s work to be done” declared Professor Lindgren.

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

References
  1. Lindgren M et al. Front Psychiatry 2020;11:603933
  2. Karpov B et al. Early Interv Psychiatry 2020. doi: 10.1111/eip.1298
  3. Lindgren M et al. J Affect Disord 2020;263:221-227
  4. Keinänen J et al. Schizophr Res 2015;169:458-463
  5. Keinänen J et al. Psychiatry Res 2018;270:547-553
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