Psychiatric comorbidity in first episode schizophrenia: a 2 year, longitudinal outcome study.
OBJECTIVE
We have previously documented a high prevalence of Axis I psychiatric comorbidity in our patients with first episode psychosis. This study sought to determine the longitudinal impact of Axis I psychiatric comorbidity on patients with first episode schizophrenia (FES) and we hypothesised that patients with psychiatric comorbidity were associated with poorer clinical and functional outcomes.


METHODS
One hundred and forty two consecutively hospitalized FES patients were included. Socio-demographic information was obtained and the PANSS, SUMD, GAF, WHOQOL-Bref were used to assess psychopathology, insight, social/occupational functioning and quality of life respectively at baseline and at 6, 12, 18 and 24 months after discharge.


RESULTS
Over time and compared with baseline scores, patients with Axis I psychiatric comorbidity (n=46, 32.4%) had significantly less reduction of their PANSS total and subscale scores, less improvement in their awareness of their psychiatric illnesses and symptoms at 12, 18 and 24 months and poorer insight into the consequences of their illness at 18 and 24 months. Poor insight at baseline was correlated positively with PANSS negative symptom subdomain, and negatively with GAF at 24 months.


CONCLUSIONS
Axis I Psychiatric comorbidity was associated with worse prospective outcomes in hospitalized patients with first episode schizophrenia, and this highlights a greater need towards the early recognition and management of these conditions.
Sim
Kang
K
Department of Adult Psychiatry, Woodbridge Hospital/Institute of Mental Health, 10, Buangkok View, Singapore 539747, Singapore. kang_sim@imh.com.sg
Chua
Thiam Hee
TH
Chan
Yiong Huak
YH
Mahendran
Rathi
R
Chong
Siow Ann
SA
D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology; D001364:Awareness; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010698:Phobic Disorders / Q000175:diagnosis / Q000453:epidemiology; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology*; D012565:Schizophrenic Psychology; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology