More than 90% of individuals experiencing a first-episode psychosis (FEP) achieved remission within two years, according to a report in JAMA Psychiatry. Among the minority who relapsed, the researchers found that they experienced delusions that were similar to those they had experienced during their initial psychotic episode.
Delusions were centered on fewer specific themes during relapse episodes, indicating that certain core delusional beliefs were consolidated. The findings suggest that “delusions may serve a critical function for individuals who experience them, and their persistence following clinical intervention further indicates how the phenomena are central to a person’s sense of meaning in daily life,” wrote Gil Grunfeld, M.Sc., and colleagues at McGill University.
The researchers analyzed data on 636 consenting subjects (average age 23.8 years; 191 female) with affective or nonaffective FEP, followed for up to two years in an early intervention service for psychosis in Montréal, Quebec, Canada. The primary outcome was positive symptom relapse and remission, including the content and severity of delusions as defined by the Scale for the Assessment of Positive Symptoms. They also sought to understand what proportion experiences delusions during their relapse episode, and the durability of delusional themes across relapses.
A total of 558 individuals (94.4%) achieved remission. Of those, only 182 (32.6%) had a subsequent relapse to a second or later episode of psychosis; a majority of those who relapsed (63.2%) had delusions, with nearly all (90.2%) experiencing delusions that were similar in content to those they experienced during their first psychotic episode. However, most of these presented with only one or two delusion themes during relapse episodes after experiencing three or more themes during their first episode.
The researchers concluded that specialized early intervention services for psychosis can achieve high rates of sustained remission. “However, in this study, the minority of individuals with delusions who later relapsed experienced similar delusion themes during subsequent episodes,” they wrote. “These findings raise important considerations for the conceptualization of delusions and have clinical implications for trajectories of illness and care.”
For related information, see the Psychiatric News article “LAI Antipsychotics Beat Oral Meds for Preventing Relapse, Hospitalization.”
(Image: Getty Images/iStock/blueshot)
Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.