Predicting first-episode psychosis patients who will never relapse over 10 years.

BACKGROUND: Although relapse in psychosis is common, a small proportion of patients will not relapse in the long term. We examined the proportion and predictors of patients who never relapsed in the 10 years following complete resolution of positive symptoms from their first psychotic episode. METHOD: Patients who previously enrolled in a 12-month randomized controlled trial on medication discontinuation and relapse following first-episode psychosis (FEP) were followed up after 10 years. Relapse of positive symptoms was operationalized as a change from a Clinical Global Impression scale positive score of <3 for at least 3 consecutive months to a score of ⩾3 (mild or more severe). Baseline predictors included basic demographics, premorbid functioning, symptoms, functioning, and neurocognitive functioning. RESULTS: Out of 178 first-episode patients, 37 (21%) never relapsed during the 10-year period. Univariate predictors (p ⩽ 0.1) of patients who never relapsed included a duration of untreated psychosis (DUP) ⩽30 days, diagnosed with non-schizophrenia spectrum disorders, having less severe negative symptoms, and performing better in logical memory immediate recall and verbal fluency tests. A multivariate logistic regression analysis further suggested that the absence of any relapsing episodes was significantly related to better short-term verbal memory, shorter DUP, and non-schizophrenia spectrum disorders. CONCLUSIONS: Treatment delay and neurocognitive function are potentially modifiable predictors of good long-term prognosis in FEP. These predictors are informative as they can be incorporated into an optimum risk prediction model in the future, which would help with clinical decision making regarding maintenance treatment in FEP.

Filial piety as a protective factor for depression in survivors of childhood abuse.

Childhood maltreatment of various types has been associated with onset of depression in adults. Previous epidemiological studies in Asian countries have confirmed a high level of childhood maltreatment, especially physical maltreatment. Yet, depression appears to be less prevalent in Asian countries than in western cultures. This study aimed to investigate the protective effect of a Chinese cultural factor, namely filial piety, against clinical depression. The study also aimed to examine the relation between filial piety, childhood maltreatment-specific inferences and adult inferential styles, so as to understand the mechanism of how filial piety protects against depression in Chinese population. Depressed outpatients (n = 80) and community controls (n = 80) were recruited from a psychiatric out-patient clinic and from community centres respectively. The two groups were compared on levels of filial piety, adult inferential styles and levels of childhood maltreatment. Depressed participants, compared to community controls, had higher levels of reported experiences of childhood maltreatment and lower levels of filial piety. Filial piety moderates adult negative inferential style and global belief of maltreatment through interacting with reported experiences of childhood maltreatment. Such moderation effect was found only in physical and emotional child maltreatment experiences, but not in sexual child maltreatment. Filial piety might be a protective factor against depression through its moderating effect on explanations and global belief of childhood maltreatment experiences.