Schizophrenia has traditionally been regarded as a severe mental illness with limited prospects of full recovery. Research on first-episode schizophrenia (FES) has provided some new insights, although there is still much to learn regarding the long-term outcomes of FES-patients. This thesis includes three papers that investigate the longitudinal development in cognition and functional outcomes, as well as examining the recovery rate in FES using consensus-based criteria of full recovery.
The first paper aimed to examine the developmental trajectories of functional outcome in patients with different levels of baseline cognition. Results indicated steady improvements in role and social functioning over a four-year period. The rate of change in social outcome varied among the patients depending on their baseline level of attention and verbal working memory, with the lowest scoring subgroup showing the least improvement. This indicated that cognitive deficits that were present at the onset of the disorder were associated with limited gains in social functioning over a period of four years.
The aim of the second paper was to compare the cognitive trajectories of FES-patients to the cognitive trajectories of a pairwise matched healthy control group over six years. The results showed an overall trend in the cognitive trajectories that indicated a similar cognitive change in both groups. The patient group’s improvement in reasoning/ problem solving was significantly larger than the control group, while improvement in working memory was smaller. This indicated that there existed different developmental trajectories for different cognitive domains and measuring cognition with a single global measure may not be sufficient.
The third paper aimed to examine the development in cognition, work, and social functioning in a group of fully recovered FES-patients across six to eight years. Additionally, we wanted to inspect whether changes in outcomes were similar when individuals were off medication as when they were on medication. The results showed steady improvements in cognition, social, and role functioning for all patients, but the changes in processing speed and work functioning were significantly larger when individuals were off antipsychotic medications than on medications. Unmedicated participants were not healthier than medicated participants at baseline. This indicated that long-term continuous medication treatment was not necessary for maintaining low levels of symptoms and good functioning over time.