Rethinking the course of psychotic disorders: modelling long-term symptom trajectories

Morgan, Craig; Dazzan, Paola; Lappin, Julia; Heslin, Margaret; Donoghue, Kim; Fearon, Paul; Jones, Peter B; Murray, Robin M; Doody, Gillian A; Reininghaus, Ulrich

Abstract

Background
The clinical course of psychotic disorders is highly variable. Typically, researchers have captured different course types using broad pre-defined categories. However, whether these adequately capture symptom trajectories of psychotic disorders has not been fully assessed. Using data from AESOP-10, we sought to identify classes of individuals with specific symptom trajectories over a 10-year follow-up using a data driven approach.

Method
AESOP-10 is a follow-up, at 10 years, of 532 incident cases with a first episode of psychosis initially identified in south-east London and Nottingham, UK. Using extensive information on fluctuations in presence of psychotic symptoms, we fitted growth mixture models to identify latent trajectory classes that accounted for heterogeneity in patterns of change in psychotic symptoms over time.

Results
We had sufficient data on psychotic symptoms during the follow-up on 326 incident patients. A four-class quadratic growth mixture model identified four trajectories of psychotic symptoms: (1) remitting-improving (58.5%); (2) late decline (5.6%); and (3) late improvement (5.4%); (4) persistent (30.6%). A persistent trajectory, compared with remitting-improving, was associated with gender (more men), black Caribbean ethnicity, low baseline education and high disadvantage, low premorbid IQ, a baseline diagnosis of non-affective psychosis, and long DUP. Numbers were small, but there were indications that those with a late decline trajectory more closely resembled those with a persistent trajectory. Conclusion Our current approach to categorising course of psychotic disorders may misclassify patients. This may confound efforts to elucidate predictors of long-term course and related biomarkers.

• Journal Article Type: Article
• Acceptance Date: Nov 12, 2020
• Online Publication Date: Feb 4, 2021
• Publication Date: Oct 4, 2022
• Deposit Date: Nov 25, 2020
• Publicly Available Date: Aug 5, 2021
• Journal: Psychological Medicine
• Print ISSN: 0033-2917
• Electronic ISSN: 1469-8978
• Publisher: Cambridge University Press
• Peer Reviewed: Peer Reviewed
• Volume: 52
• Issue: 13
• Pages: 2641-2650
• DOI: https://doi.org/10.1017/s0033291720004705
• Keywords: Psychotic Disorder, Course and Outcome, Epidemiology, Growth Mixture Models
• Public URL: https://nottingham-repository.worktribe.com/output/5070325
• Publisher URL: https://www.cambridge.org/core/journals/psychological-medicine/article/rethinking-the-course-of-psychotic-disorders-modelling-longterm-symptom-trajectories/0A33F9117A9028C441A2B24EC2997F45#article
• Additional Information: Copyright: Copyright © The Author(s) 2021. Published by Cambridge University Press; License: This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.; Free to read: This content has been made available to all.