Outcomes in Schizophrenia Systematic Reviews

Transcription

1 Outcomes in Schizophrenia Systematic Reviews Jouko Miettunen Professor of Clinical Epidemiology Center for Life Course Epidemiology and Systems Medicine, University of Oulu, Finland This project is co-funded by the EC under H2020 research and innovation

2 AIMS The aim is to present recent systematic reviews related to long-term outcome of schizophrenia. Included reviews focus different aspects of schizophrenia Proportion of recovery Duration of untreated psychosis (DUP) as a predictor of outcome Family history of psychosis as a predictor of functional outcome 2

3 General methods of included systematic reviews several electronic databases Scopus, PubMed, Science Direct, ISI Web of Knowledge, PsycINFO (Ovid), CINAHL (EBSCO) and Academic Search Premier (EBSCO) and manual literature search Included articles were required to meet following criteria: at least 80% of the participants were individuals with a schizophreniaspectrum diagnosis follow-up time was at least 2 years since onset of illness majority of the subjects were older than 16 years at the onset of psychotic symptoms Clinical trials were excluded 3

4 Recovery criteria: improvements in both clinical and social domains and evidence that improvement in at least one of these two domains had persisted for at least two years 4

5 Recovery in schizophrenia In 50 studies, the median proportion of recovery was 13.5% Mean 16.4%, range 0-58% Studies from sites in countries with poorer economic status had higher recovery proportions. 5

6 Recovery in subpopulations 6

7 Gender differences in recovery 7

8 Recovery - Conclusion Based on the best available data, approximately one in seven individuals with schizophrenia met our criteria for recovery. Large heterogeneity in results and in methods. Despite major changes in treatment options in recent decades, the proportion of recovered cases has not increased. This project is co-funded by the EC under H2020 research and innovation 8

9 Duration of untreated psychosis and outcome 9

10 Duration of untreated psychosis and outcome 10

11 DUP - Conclusion Longer duration of untreated psychosis associated with poorer outcomes Average effect sizes were quite small Results indicate that early intervention may have subtle positive effects on outcome of schizophrenia This project is co-funded by the EC under H2020 research and innovation 11

12 Family history of psychosis and outcome 12

13 Family history of psychosis and global outcome 13

14 Family history - Conclusion Based on the review the presence of family history of psychosis has a relatively small but statistically significant negative effect on the occupational and global (i.e. combined occupational, social and clinical) outcome. This was the first systematic review on effects of family history on social aspects of outcome in schizophrenia. A previous review (Esterberg et al. Schizophr Res 2010; 120:121-30) has found a small but significant negative effect of family history on negative symptoms but not on positive symptoms (no follow-up required). These results have clinical relevance, such as possibility to direct interventions to the patient group with increased risk of poorer outcome. 14

15 Other potential outcome predictors Substance use Approximately 25% of schizophrenia patients have a cannabis use disorder and 20% have a alcohol use disorder Koskinen et al. Acta Psychiatr Scand 2009; 120:85-96 Koskinen et al. Schizophr Bull 2010; 36: Those who continue to abuse substances have worse outcome Gupta et al. Aust N Z J Psychiatry. 2013; 47: Large et al. Aust N Z J Psychiatry 2014; 48: Medications and medication adherence Leucht et al. Lancet 2012; 379: Emsley et al. BMC Psychiatry 2013; 13:50 Zipursky et al. J Clin Psychiatrry 2014; 75 (Suppl. 2):20-24 Onset age? Marital status? Adverse life events? 15

16 Main references Jääskeläinen E, Juola P, Hirvonen N, McGrath JJ, Saha S, Isohanni M, Veijola J, Miettunen J. A systematic review and meta-analysis of recovery in schizophrenia. Schizophr Bull 2013; 39: Käkelä J, Panula J, Oinas E, Hirvonen N, Jääskeläinen E, Miettunen J. Family history of psychosis and social, occupational and global outcome in schizophrenia: a meta-analysis. Acta Psychiatr Scand 2014; 130: Penttilä M, Jääskeläinen E, Hirvonen N, Isohanni M, Miettunen J. Duration of untreated psychosis as predictor of long-term outcome in schizophrenia. A systematic review and metaanalysis. Br J Psychiatry 2014; 205:

17 Jouko Miettunen, prof.; Erika Jääskeläinen, adjunct prof. Center for Life Course Epidemiology and Systems Medicine, University of Oulu, Oulu, Finland & Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland Matti Penttilä, MScD; Pauliina Juola, MScD; Juha Käkelä, BMed; Matti Isohanni, prof. Center for Clinical Neurosciences, University of Oulu, Oulu, Finland & Department of Psychiatry, Oulu University Hospital, Oulu, Finland Noora Hirvonen, MA Information Studies, Faculty of Humanities, University of Oulu, Oulu, Finland John J McGrath, prof; Sukanta Saha, PhD University of Queensland, St Lucia, Australia This project is co-funded by the EC under H2020 research and innovation jouko.miettunen@oulu.fi / 17