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Risk factors for relapse following treatment for first episode psychosis : A systematic review and meta-analysis of longitudinal studies
Alvarez-Jimenez, Mario Priede, A. Hetrick, Sarah Bendall, Sarah Killackey, Eoin Parker, Alexandra McGorry, Patrick Gleeson, John
Alvarez-Jimenez, Mario
Priede, A.
Hetrick, Sarah
Bendall, Sarah
Killackey, Eoin
Parker, Alexandra
McGorry, Patrick
Gleeson, John
Abstract
Background
Preventing relapse is an essential element of early intervention in [http://www.sciencedirect.com/topics/page/Psychosis] psychosis, but relevant risk factors and precise relapse rates remain to be clarified. The aim of this study was to systematically compile and analyse risk factors for and rates of relapse in the early course of psychosis. Methods Systematic review and [http://www.sciencedirect.com/topics/page/Meta-analysis] meta-analysis of English and non-English language, peer-reviewed, [http://www.sciencedirect.com/topics/page/Longitudinal_study] longitudinal studies, with a minimum 12-month follow-up and at least 80% of participants diagnosed with a first episode of psychosis (FEP) that reported risk factors for relapse. Results Of 153 potentially relevant articles, 29 were included in the study. Pooled prevalence of relapse of positive symptoms was 28% (range = 12–47%), 43% (35–54%), 54% (40–63%) at 1, 1.5–2, and 3 years follow-up, in that order. A total of 109 predictors were analysed, with 24 being assessed in at least 3 studies. Of those, 20 predictors could be extracted for meta-analysis. Medication non-adherence, persistent [http://www.sciencedirect.com/topics/page/Substance_use_disorder] substance use disorder, carers' critical comments (but not overall expressed emotion) and poorer premorbid adjustment, increased the risk for relapse 4-fold, 3-fold, 2.3-fold and 2.2-fold, respectively. Conclusions
Clinical variables and general demographic variables have little impact on relapse rates. Conversely, non-adherence with medication, persistent substance use disorder, carers' criticism and poorer premorbid adjustment significantly increase the risk for relapse in FEP. Future studies need to address the methodological limitations of the extant research (e.g. definition of relapse), focus on the identification of protective factors and evaluate theoretically derived models of relapse.
Keywords
Date
2012
Type
Journal article
Journal
Schizophrenia Research
Book
Volume
139
Issue
1-3
Page Range
116-128
Article Number
ACU Department
School of Behavioural and Health Sciences
Faculty of Health Sciences
Faculty of Health Sciences
Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled