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Title: Methodological perspectives on the heterogeneity in schizophrenia outcome
Author: Hammond, G. C.
Awarding Body: University of Cambridge
Current Institution: University of Cambridge
Date of Award: 2008
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In this thesis, longitudinal outcomes are reported from a prospective study of schizophrenia patients followed over three years (the Schizophrenia Outpatients Health Outcomes study). Categorical and continuous latent variable models were applied in SOHO to outcomes spanning four domains: clinical symptoms, Health-related Quality of Life, functional and anti-social. Longitudinal analyses ewer also performed on prescribing patterns for antipsychotic medications. Application of contemporary latent variable methods and maximum likelihood estimation, allowed for measurement error, inclusion of subjects with partially missing data, and assessment of individual or group differences in illness course (patient heterogeneity modelling). Latent trajectory analysis using growth models confirmed the positive response to treatment that is typically found when medication is changed, with greatest improvement over the first year. Frequency of social contact and HRQoL showed corresponding increases and trends. Heterogeneity of change was observed for all outcomes with individuals varying in their rate of change, and final level, regardless of outcome. Functional and anti-social outcomes showed less marked responses to treatment. Markov analysis (health state change) for all categorical outcomes provided evidence for three sub-groups with qualitatively different course types: those remaining in their original state of either impairment or non-impairment (stayers) and those who changed over time, transitioning between states in each direction. These longitudinal outcome profiles and course types were contrasted using demographic and treatment-related attributes. Younger age, shorter duration of illness, female gender, and lack of previous treatment were associated with lack of HRQoL impairment, anti-social outcomes, and higher levels of functioning. Sustained medication compliance and a prior hospital admission (before study entry) was also predictive of more favourable course. Groups with better course types in one outcome tended to have good course types in others, although deviations from this pattern were observed.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available