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Background: From the first episode (FEP), the course of psychosis is marked by substantial heterogeneity of clinical and functional outcomes which poses significant challenges in providing prognostic guidance to patients and families. To better understand such heterogeneity within the context of early interventions servives (EIS), this study aimed to examine latent trajectories of positive, negative symptoms and functioning among FEP individuals undergoing EIS. Study design: The Prevention and Early Intervention Program for Psychoses (PEPP-Montreal) is a 2-year EIS for FEP that conducted longitudinal assessments of 689 individuals aged 14-35, including sociodemographics, cognition, psychopathology, and functioning. Latent growth mixture modelling was used to identify distinct patterns of clinical and functional trajectories. The inter-relationship between trajectories, and the association of trajectory membership with baseline characteristics and distal outcomes were investigated using the manual three-step approach.Study results: Two positive symptom trajectories (Stable-low -32%, Fluctuating -68%,), three negative symptom trajectories (Decreasing -41%, Fluctuating -15%, Stable-high -44%,) and two functioning trajectories (Increasing -57%, Stable-moderate -43%) were identified. Early treatment response, particularly on negative symptoms, consistently and strongly predicted better outcome trajectories (OR=3.4-5.5). Trajectories of higher symptom severity were associated with trajectory of worse functioning (RR=1.5-2.2), which exhibited lower rates of clinical and functional remission. Conclusion: These findings offer insights into clinically meaningful subgroups of individuals that could inform the prognosis of FEP and the development of individually tailored EIS. Individuals who do not show early improvement in negative symptoms may benefit from earlier psychosocial interventions specifically targeting actionable factors that contribute to secondary negative symptoms.
Sert et al. (Fri,) studied this question.