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Long term course and outcome of first episode schizophrenia: a 27-to-31-year follow-up

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Abstract

Purpose

To describe long term clinical and functional outcomes of schizophrenia in a developed country.

Method

Long term longitudinal study of clinical and functional outcomes of incidence cohort of all consecutive admissions for a first hospitalization for schizophrenia between 1983 and 1987 in Montreal, Canada (n = 142). Data collection was conducted at admission, 5 years, 10–16 years and 27–31 years follow-up by reviewing hospital charts and government linked health administrative databases.

Results

One fifth of patients were never re-hospitalized and 35% were still in contact with the same catchment area psychiatric services. Thirty-four (24%) died on average at 45.5 years. Fourteen (9.9%) died by suicide; half of them did so 10 years after their first hospitalization. Over 20% were exposed to clozapine and nearly 50% to long-acting injectable antipsychotic medication. There were no inmates; an estimated one fifth might be inferred to be living in supervised residential settings and the rest lived alone or with family. Approximately three quarters of the patients under 65 were receiving social assistance benefits at study’s end. From 15 to 25% might have been employed (supported or competitive employment).

Conclusion

This study confirms that the long-term course of schizophrenia is heterogenous and mostly positive with most patients living in the community, although a significant proportion need long term support and an important proportion experience premature death. To mitigate the persistent suicide risk and to respond to their need for support, continuous mental health professional’s involvement is required for many.

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Data availability

The Commission d’Accès à l’Information (CAI) did not grant the authors authorization to allow third parties access to the data supplied.

Code availability

None.

References

  1. Abdel-Baki A, Lesage A, Nicole L et al (2011) Schizophrenia: an illness with bad outcome: myth or reality. Can J Psychiatry 56:92–101

    Article  Google Scholar 

  2. Hopper K, Wanderling J (2000) Revisiting the developed versus developing country distinction in course and outcome in schizophrenia: results from ISoS, the WHO collaborative follow-up project. Schizophr Bull 4:835–846

    Article  Google Scholar 

  3. Helgason L (1990) Twenty years’ follow-up of first psychiatric presentation for schizophrenia: what could have been prevented? Acta Psychiatr Scand 81:231–235

    Article  CAS  Google Scholar 

  4. Kua J, Wong KE, Kua EH et al (2003) A 20-year follow-up study on schizophrenia in Singapore. Acta Psychiatre Scand 108:118–125

    Article  CAS  Google Scholar 

  5. Kurihara T, Kato M, Reverger R et al (2005) Eleven-year clinical outcome of schizophrenia in Bali. Acta Psychiatr Scand 122:456–462

    Article  Google Scholar 

  6. Harrison G, Hopper K, Craig T et al (2001) Recovery time from psychotic illness: a 15 and 25 year international follow-up study. Br J Psychiatry 178:506–517

    Article  CAS  Google Scholar 

  7. Wiersma D, Wanderling J, Dragomirecka E et al (2000) Social disability in schizophrenia: its development and prediction over 15 years in incidence cohorts in six European centres. Psychol Med 30:1155–1167

    Article  CAS  Google Scholar 

  8. Mason P, Harrison G, Glazebrook C et al (1995) Characteristics of outcome in schizophrenia at 13 years. Br J Psychiatry 167:596–603

    Article  CAS  Google Scholar 

  9. An der Heiden W, Krumm B, Muller S et al (1995) The Mannheim long-term study of schizophrenia. Initial results of follow-up of the illness over 14 years after initial inpatient treatment. Nervenarzt 66:820–827

    Google Scholar 

  10. Wiersma D, Nienhuis FJ, Sloof CJ et al (1998) Natural course of schizophrenic disorders: a 15 year followup of a Dutch incidence cohort. Schizophr Bull 24:75–85

    Article  CAS  Google Scholar 

  11. Bland RC, Parker JH, Orn H (1976) Prognosis in schizophrenia. A ten year follow-up of first admissions. Arch Gen Psychiatry 33:949–954

    Article  CAS  Google Scholar 

  12. Newman SC, Bland RC, Thompson AH (2012) Long-term course and outcome in schizophrenia: a 34-year follow-up study in Alberta, Canada. Psychol Med 42:2137–2143

    Article  CAS  Google Scholar 

  13. Nicole L, Lesage A, Lalonde P (1992) Lower incidence and increased male:female ratio in schizophrenia. Br J Psychiatry 161:556–557

    Article  CAS  Google Scholar 

  14. McGrath J, Saha S, Chant D et al (2008) Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiol Rev 30:67–76

    Article  Google Scholar 

  15. Vanasse A, Courteau J, Fleury MJ et al (2012) Treatment prevalence and incidence of schizophrenia in Quebec using a population health services perspective different algorithms, different estimates. Soc Psychiatry Psychiatr Epidemiol 47:533–543

    Article  Google Scholar 

  16. Lehman AF (1995) Vocational rehabilitation in schizophrenia. Schizophr Bull 21:645–656

    Article  CAS  Google Scholar 

  17. Cook JA, Blyler CR, Burke-Miller JK et al (2008) Effectiveness of supported employment for individuals with schizophrenia: results from a multi-site, randomized trial. Clin Schizophr Relat Psychoses 2:37–46

    Article  Google Scholar 

  18. Lesage AD, Émond V. Number 6: surveillance of mental disorders in Québec: prevalence, mortality and service utilization profile. Chronic disease surveillance. Quebec City (Quebec): Institut national de santé publique du Québec, 2013 Jul 17. Report No.: ISBN: 978-2-550-68121-2 (PDF).

  19. Ventriglio A, Gentile A, Bonfitto I et al (2016) Suicide in the early stages of schizophrenia. Front Psychiatry 116:1–9

    Google Scholar 

  20. Solanki RK, Singh P, Munshi D (2009) Current perspectives in the treatment of resistant schizophrenia. Indian J Psychiatry 51:254–260

    Article  CAS  Google Scholar 

  21. Vanasse A, Blais L, Courteau J et al (2016) Comparative effectiveness and safety of antipsychotic drugs in schizophrenia treatment: a real world observational study. Acta Psychiatr Scand 134:374–384

    Article  CAS  Google Scholar 

  22. Brissos S, Veguilla MR, Taylor D et al (2014) The role of long-acting injectable antipsychotics in schizophrenia: a critical appraisal. Ther Adv Psychopharmacol 4:198–219

    Article  CAS  Google Scholar 

  23. Stip E, Abdel-Baki A, Roy MA, et al. Antipsychotiques à action prolongée: révision de l’algorithme QAAPAPLE. Can J Psychiatry. 2019 :697–707

  24. Brunet A, Cyr M, Toupin J et al (2013) Alcohol and drug use in a group of psychotic patients: extent of use according to different inquiry practices. Can J Commun Mental Health 12:139–141

    Google Scholar 

  25. Erlangsen A, Andersen PF, Toender A et al (2017) Cause specific life years lost in people with mental disorders: a nationwide, register-based cohort study. Lancet 2:937–945

    Google Scholar 

  26. Brousselle A, Lamothe L, Sylvain C et al (2010) Integrating services for patients with mental and substance use disorders: what matters? Health Care Manage Rev 23:212–223

    Article  Google Scholar 

  27. Merkes M, Lewis V, Canaway R (2010) Supporting good practices in the provision of services to people with comorbid mental health and alcohol and other drug problems in Australia: describing key elements of good practice models. BMC Health Serv Res 10:325

    Article  Google Scholar 

  28. Harding CM, Brooks GW, Ashikaga T et al (1987) The Vermont longitudinal study of persons with severe mental illness, I: methodology, study sample, and overall status 32 years later. Am H Psychiatry 144:718–726

    Article  CAS  Google Scholar 

  29. Ciompi L (1980) Catamnestic long-term study on the course of life and aging of schizophrenics. Schizophr Bull 6:606–618

    Article  CAS  Google Scholar 

  30. Geddes JR, Kendell RE (1995) Schizophrenic subjects with no history of admission to hospital. Psychol Med 25:859–868

    Article  CAS  Google Scholar 

  31. Conseil d’évaluation des technologies de la santé du Québec. Assertive community treatment for people with persistent and particularly severe mental illness (CETS 99–1 RE). Montreal, Quebec: AÉTMIS, 2001, xvii–78 p. (Original French version published in May 1999).

  32. Fleury MJ (2005) Quebec mental health service networks: models and implementation. Int J Integr Care 5:e07

    Article  Google Scholar 

  33. Crilly J (2007) The history of clozapine and its emergence in the US market: a review and meta-analysis. Hist Psychiatry 18(1):39–60

    Article  Google Scholar 

  34. Nolin M, Malla A, Tibbo P (2016) Early intervention for psychosis in Canada: what is the state of affairs? Can J Psychiatry 61(3):186–194

    Article  Google Scholar 

  35. National Institute for Health and Care Excellence (NICE) (2013) Psychosis and schizophrenia in children and young people – recognition and management. NICE clinical guidelines 1552013 Manchester, England. NICE, Manchester, England

    Google Scholar 

  36. Bertelsen M, Jeppesen P, Petersen L et al (2009) Course of illness in a sample of 265 patients with first episode–five year follow-up of the Danish OPUS trial. Schizophr Res 107(2–3):273–278

    Google Scholar 

  37. Lesage AD, Bland R (2014) Consensus statement on improving mental health transitions. IHE Report, Institute of Health Economics

    Google Scholar 

  38. Addington D, Abidi S, Garcia-Ortega I et al (2017) Canadian guidelines for the assessment and diagnosis of patients with schizophrenia spectrum and other psychotic disorders. Can J Psychiatry 62:594–603

    Article  Google Scholar 

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Acknowledgements

We would like to thank Ms. Mila Mansour (medical student) and Ms. Marie Désilets for their contribution to this project. In memory of Dr. Luc Nicole.

Funding

Funding was provided by the Fondation de l’Institut Universitaire en Santé Mental de Montréal.

Author information

Authors and Affiliations

  1. Hôpital Rivières des Prairies, Département de psychiatrie, Université de Montréal, Montréal, Québec, Canada

    Lori Baltazar

  2. Institut Universitaire en Santé Mentale de Montréal, Département de psychiatrie, Université de Montréal, Montréal, Québec, Canada

    Luigi De Benedictis & Pierre Lalonde

  3. Centre Hospitalier Universitaire de Montréal, Département de psychiatrie, Université de Montréal, Montréal, Québec, Canada

    Amal Abdel-Baki

  4. Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Département de psychiatrie, Université de Montréal, Montréal, Québec, Canada

    Alain Lesage

  5. Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, 7401 rue Hochelaga, Montréal, Québec, H1N 3M5, Canada

    Lori Baltazar

Authors
  1. Lori Baltazar
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  2. Luigi De Benedictis
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  3. Amal Abdel-Baki
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  4. Pierre Lalonde
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  5. Alain Lesage
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Corresponding author

Correspondence to Lori Baltazar.

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Ethical approval

This research project received the approval of the ethics committee of the Insitut Universitaire en Santé Mentale de Montréal (IUSMM).

Consent to participate

Data collection was authorized by the IUSMM and the Commission d’Accès à l’Information (CAI). A retrospective chart review was conducted, therefore informed consent from participants was not required.

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Ethics approval was received and all authors agree to publish.

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Baltazar, L., De Benedictis, L., Abdel-Baki, A. et al. Long term course and outcome of first episode schizophrenia: a 27-to-31-year follow-up. Soc Psychiatry Psychiatr Epidemiol 57, 1319–1328 (2022). https://doi.org/10.1007/s00127-021-02185-8

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  • DOI: https://doi.org/10.1007/s00127-021-02185-8

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