Predictors of 10-year outcome of first-episode psychosis.
BACKGROUND
Predictors of outcome for psychosis are poorly understood. Duration of untreated psychosis (DUP) appears to predict short-term outcome although its medium- to long-term role remains unclear. Neurodevelopmental indices such as pre-morbid function and/or neurological soft signs may predict longer-term outcome. We aimed to assess the impact of a range of clinical and demographic variables on long-term outcome of a geographically defined, epidemiological first-episode psychosis cohort.


METHODS
A 10-year follow-up was undertaken of a consecutively presenting sample of 109 cases of first-episode psychosis aged 16-50 years. Baseline assessments included positive, negative and depression symptoms, DUP, neurological soft signs and pre-morbid functioning. Multi-dimensional outcomes were assessed blind to baseline data.


RESULTS
All participants were traced at a mean of 10.5 years post-index admission: 11 had died, 10 from non-natural causes. Of the surviving cases, 70% were comprehensively re-assessed by interview. Summary data on the remainder were collected from their family practitioner and chart review. Poor 10-year outcomes were predicted independently by poor pre-morbid functioning, baseline negative symptoms and longer DUP. The same measures, plus neurological soft signs, appeared to predict outcomes in a DSM-IV schizophrenia/schizo-affective subgroup.


CONCLUSIONS
Poor pre-morbid functioning, baseline symptoms, DUP and neurological soft signs at onset independently predict poor long-term outcome in first-episode psychosis.
White
C
C
Division of Psychiatry, University of Manchester, Manchester, UK.
Stirling
J
J
Hopkins
R
R
Morris
J
J
Montague
L
L
Tantam
D
D
Lewis
S
S
D000328:Adult; D001925:Brain Damage, Chronic / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D010343:Patient Admission; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D012559:Schizophrenia / Q000175:diagnosis* / Q000628:therapy; D012565:Schizophrenic Psychology; D012917:Social Adjustment; D055815:Young Adult