title: Early determinants of four-year clinical outcomes in bipolar disorder with psychosis.
abstract: OBJECTIVE
  Bipolar disorder with psychosis is common in inpatient settings and is associated with diverse outcomes after hospital discharge, which can range from a return to premorbid functioning with no recurrence, to a chronic or recurring illness. Less is known, however, about factors that can predict a better or worse clinical outcome. The present study sought to assess four-year clinical outcomes and their predictors in patients hospitalized for bipolar I disorder with psychosis.
  
  
  METHODS
  Participants from the Suffolk County Mental Health Project (SCMHP) with a baseline diagnosis of bipolar I disorder with psychotic features (N=126) were reassessed using face-to-face interviews at six months, two years, and four years following their first hospitalization. At each time point, clinical status, role functioning, and treatment were assessed by highly trained interviewers using standardized instruments.
  
  
  RESULTS
  The majority of participants (73.2%) returned to their premorbid level of role functioning by the four-year follow-up and the median percentage of time ill during the interval was less than 20%. Nevertheless, almost half of the sample (46.9%) was rehospitalized at least once. Psychotic symptoms at baseline (particularly Schneiderian symptoms), depressive phenomenology, childhood psychopathology, and younger age at first hospitalization predicted worse outcome, whereas mood-incongruent psychotic features and age of mood disorder onset did not.
  
  
  CONCLUSIONS
  The four-year outcomes of a first-admission cohort with bipolar I disorder with psychosis were generally favorable. Poorer premorbid functioning, Schneiderian delusions, greater depressive symptoms, and a younger age of first hospitalization portend a worse course.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stony Brook University School of Medicine, Stony Brook, NY, USA. gabrielle.carlson@sbumed.org
authors.forename: Gabrielle A
authors.initials: GA
authors.lastname: Carlson
authors.forename: Roman
authors.initials: R
authors.lastname: Kotov
authors.forename: Su-Wei
authors.initials: SW
authors.lastname: Chang
authors.forename: Camilo
authors.initials: C
authors.lastname: Ruggero
authors.forename: Evelyn J
authors.initials: EJ
authors.lastname: Bromet
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001714:Bipolar Disorder / Q000150:complications* / Q000453:epidemiology* / Q000523:psychology; D003702:Delusions; D003863:Depression; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000150:complications* / Q000453:epidemiology; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome