Determinants of real-world functioning in first-episode psychosis patients receiving 4 weeks of amisulpride treatment: findings from the multinational OPTiMiSE study

Abstract

INTRODUCTION: Identifying factors that promote real-world functioning in patients with first-episode psychosis (FEP) may guide the development of effective interventions. OBJECTIVE: To determine factors associated with real-world functioning in FEP patients after 4 weeks of amisulpride treatment. METHODS: A total of 354 FEP patients were included. Baseline assessments covered socio-demographic and clinical data, the Positive and Negative Syndrome Scale (PANSS), and the Calgary Depression Rating Scale. Real-world functioning was assessed at week 4 using the Personal and Social Performance scale. RESULTS: After 4 weeks, 69.2 % of patients were in remission, while 27.7 % showed good real-world functioning. More years of education (estimator = 0.54) and lower baseline levels of depressive (estimator = -0.37) and amotivational symptoms (estimator = -0.79) were protective factors for general functioning. Non-remission at week 4 (estimator = 15.33) significantly increased the risk of poor functioning. Amotivation and non-remission were also linked to worse outcomes in work and social relationships areas. Regarding self-care, more years of education (estimator = -0.04), fewer depressive symptoms (estimator = 0.03), and not using cannabis (estimator = -0.19) were protective. For aggressive behavior functioning, higher levels of diminished expression (estimator = -0.03), lower levels of depressive symptoms (estimator = 0.02) and positive symptoms (estimator = 0.02), as well as remission at week 4 (estimator = -0.37), were protective. CONCLUSION: Negative symptoms, specifically amotivation and diminished expression, play a key role in real-world functioning. Amotivation impacts general and domain-specific functioning, while positive symptoms and diminished expression mainly affect aggressive behaviors area.