Trajectories and antecedents of treatment response over time in early-episode psychosis

Schizophr Bull. 2010 May;36(3):624-32. doi: 10.1093/schbul/sbn120. Epub 2008 Oct 9.


Background: Little is known about the extent of heterogeneity of symptomatology in treated early-onset psychosis. The current study aims to quantify the extent of heterogeneity in trajectories of treated symptom severity in early-episode psychosis and their antecedents.

Methods: Data were from 491 persons with early-episode psychosis from a clinical trial of haloperidol and risperidone. Positive and Negative Syndrome Scale (PANSS) administrations were used to measure symptom severity trajectories for (a) rapid treatment response scores over 4 weeks and (b) medium-term course over 24 weeks. Baseline antecedents included sex, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis, age of onset, the Premorbid Adjustment Scale, and a cognitive test battery. Symptom severity trajectories were calculated with mixed mode latent class regression modeling from which groups were derived.

Results: Five groups based on PANSS scores over time were identified. Over 4 weeks, 3 groups with varied baseline PANSS scores (54-105) did not surpass 30% PANSS improvement. Another group improved and then was stable (n = 76,15.3%), and another showed marked improvement (n = 94,18.9%). Logistic regression showed that membership in the best response trajectory was associated with not having a diagnosis of schizophrenia, good premorbid functioning, and higher cognitive functioning, whereas membership in the poor response trajectory was associated with earlier age of onset and poorer cognitive functioning.

Conclusion: Amelioration generally characterizes treated symptom severity. Age of onset, diagnosis, cognitive functioning, and premorbid functioning have prognostic value in predicting treatment response trajectories.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Age of Onset
  • Antipsychotic Agents / therapeutic use*
  • Cognition Disorders / diagnosis
  • Cognition Disorders / drug therapy
  • Double-Blind Method
  • Early Diagnosis
  • Female
  • Follow-Up Studies
  • Haloperidol / therapeutic use*
  • Humans
  • Male
  • Prognosis
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Psychometrics
  • Psychotic Disorders / diagnosis*
  • Psychotic Disorders / drug therapy*
  • Psychotic Disorders / psychology
  • Risperidone / therapeutic use*
  • Schizophrenia / diagnosis*
  • Schizophrenia / drug therapy*
  • Schizophrenic Psychology*
  • Treatment Outcome
  • Young Adult


  • Antipsychotic Agents
  • Haloperidol
  • Risperidone