New research from RCSI’s Department of Psychiatry indicates a more positive outlook than previously understood for people diagnosed with first episode psychosis and first episode schizophrenia. The research, led by Dr John Lally and Prof Kieran Murphy at RCSI, has been published in the British Journal of Psychiatry.

For the first time in psychosis research, a large meta-analysis of remission and recovery was conducted. The study found that 58% of patients with first episode psychosis were likely to experience remission (over an average follow up of 5.5 years), while 38% are likely to experience recovery (over an average follow up of 7.2 years). This is higher than previously identified remission and recovery rates.

Remission is defined as absent psychotic symptoms for at least six months. Recovery is defined as both symptomatic and functional improvement (including social, educational and occupational domains) for at least two years. 

A key factor behind the difference in remission and recovery rates identified in this research is that previous reviews included people with both first-episode and multi-episode disorders. Multi-episode patients include those with more chronic or treatment resistant illness, who would be expected to have lower recovery rates. A previous review in schizophrenia identified that only one in seven patients had a functional recovery. This study identifies that 1 in 3 of people with a first episode schizophrenia will meet criteria for recovery.

The research also identified stability of recovery rates after the first two years, suggesting that a progressive deterioration of the illness is not typical.

According to Dr John Lally, “Despite the increased focus on the early recognition and treatment of first episode psychosis over the past two decades, there had been no analysis of remission and recovery rates. Until now the prognosis for those diagnosed with first episode psychosis was bleak. What we have discovered gives hope that they have a much better chance of experiencing a long-term recovery than previously understood. Our finding that recovery rates have not improved over time to the same extent as remission rates raises questions about the effectiveness of services as currently delivered in achieving improved recovery.”

Dr Lally and colleagues will now explore why recovery rates have not improved over the past twenty years compared to the previous twenty years.  They will conduct a review and meta-analysis of social outcomes and re-hospitalisation rates for people with first-episode psychosis, to begin to provide a comprehensive description of recovery related outcomes and ones which are important to patients and their families.