Three-year outcome of first-episode psychoses in an established community psychiatric service.
BACKGROUND
Changes in service provision, secular trends in substance misuse and changing social structures might affect outcome in psychosis.


OBJECTIVE
To assess the three-year outcome of an inception cohort of first-episode psychoses treated in a modern, community-oriented service; to compare outcomes with an earlier cohort treated in hospital-based care; and to examine the predictive validity of ICD-10 diagnostic criteria.


METHODS
Three-year follow-up (1995-1997) of an inception cohort of first-episode psychoses and comparison with two-year follow-up (1980-1982) of the Determinants of Outcome of Severe Mental Disorders (DOSMED) Nottingham cohort.


RESULTS
On most outcome measures, non-affective psychoses had a worse outcome than affective psychoses. Affective psychoses had better outcome than previously reported. Substance-related psychoses had very poor occupational outcome. Similar proportions of the current and DOSMED cohort were in remission but the former were rated as having greater disability.


CONCLUSIONS
In a modern community service, 30-60% of patients with first-episode psychoses experience a good three-year outcome. The ICD-10 criteria have good predictive validity.
Singh
S P
SP
Division of Psychiatry, University of Nottingham.
Croudace
T
T
Amin
S
S
Kwiecinski
R
R
Medley
I
I
Jones
P B
PB
Harrison
G
G
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000458:organization & administration*; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011237:Predictive Value of Tests; D011618:Psychotic Disorders / Q000145:classification / Q000175:diagnosis / Q000534:rehabilitation*