title: Two-year outcomes in first-episode psychotic depression the McLean-Harvard First-Episode Project.
abstract: OBJECTIVE
  Early assessment can guide accurate diagnosis, prognosis, and treatment-planning for patients with major mental illnesses. Longitudinal studies in psychotic depression from onset are rare, encouraging the present study.
  
  
  METHODS
  We followed 56 DSM-IV MDD patients with psychotic features prospectively and systematically to assess course and predictors of operationally-defined syndromal remission, syndromal recovery, symptomatic remission, functional recovery, and new episodes, and to evaluate diagnostic stability.
  
  
  RESULTS
  Among 49/56 cases followed for ≥2 years, 59% retained the initial diagnosis and most achieved syndromal remission (86%) and recovery (84%); 58% remitted symptomatically, and only 35% (17/49) recovered functionally. Syndromal recovery was earlier following subacute onset, lower initial depression scores, and lack of moodincongruent psychotic features. Within 2 years, 45% (22/49) experienced new episodes - earlier with younger onset and higher CGI scores. DSM diagnosis changed in 41%, to bipolar (33%), or schizoaffective disorders (12%), which followed early mania-like or schizophrenia-like features, respectively.
  
  
  CONCLUSIONS
  Within 2 years of first-hospitalizations, 41% of patients initially diagnosed with psychotic-depression met criteria for DSM-IV bipolar or schizoaffective disorders. Of the 59% retaining the initial diagnosis for 2 years, nearly half experienced new episodes, 42% remained symptomatic, and two-thirds failed to regain their own prior functional status.
authors.affiliation: University of Texas Health Science Center at San Antonio, United States; Department of Psychiatry, Harvard Medical School & McLean Hospital, Belmont, MA, United States. Electronic address: tohen@uthscsa.edu.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Tohen
authors.affiliation: Department of Psychiatry, Harvard Medical School & McLean Hospital, Belmont, MA, United States.
authors.forename: Hari-Mandir K
authors.initials: HK
authors.lastname: Khalsa
authors.affiliation: Department of Psychiatry, Harvard Medical School & McLean Hospital, Belmont, MA, United States; Section of Psychiatry, Department of Neuroscience, University of Parma, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Salvatore
authors.affiliation: Department of Psychiatry, Harvard Medical School & McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Vieta
authors.affiliation: Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA, United States.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Ravichandran
authors.affiliation: Department of Psychiatry, Harvard Medical School & McLean Hospital, Belmont, MA, United States.
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Baldessarini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000175:diagnosis*; D003865:Major Depressive Disorder / Q000175:diagnosis*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011618:Psychotic Disorders / Q000175:diagnosis*; D055815:Young Adult