Subtyping first-episode non-affective psychosis using four early-course features: potentially useful prognostic information at initial presentation.
OBJECTIVE
Heterogeneity of symptoms, course and outcomes in primary psychotic disorders complicates prognosis, treatment and diverse aspects of research. This study aimed to identify interpretable subtypes of first-episode non-affective psychosis based on four early-course features (premorbid academic functioning, premorbid social functioning, duration of the prodrome and age at onset of psychosis).


METHODS
Data from 200 well-characterized patients hospitalized in public-sector inpatient units for first-episode non-affective psychosis were used in latent profile analyses. Derived subtypes were then compared along a number of clinical dimensions using analyses of variance.


RESULTS
Using four early-course features, three classes were derived. A good premorbid/short prodrome subtype was characterized by a lower severity of positive symptoms, better social/occupational/global functioning, and a shorter duration of untreated psychosis; a poor premorbid/early onset subtype demonstrated greater negative and preoccupation symptoms, as well as greater psychosocial problems; and a long prodrome/late onset subtype was characterized by greater dysphoric symptoms.


CONCLUSIONS
Findings indicate a need for further research with first-episode samples on the utility of subtyping based on early-course (premorbid, prodromal and onset-related) characteristics. Such efforts could enhance the parsing of heterogeneity, thereby advancing clinical practice and research.
Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Michael T
MT
Compton
Mary E
ME
Kelley
Dawn F
DF
Ionescu
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D042241:Early Diagnosis; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D062706:Prodromal Symptoms; D011379:Prognosis; D011618:Psychotic Disorders / Q000145:classification* / Q000175:diagnosis* / Q000453:epidemiology; D012919:Social Behavior; D055815:Young Adult
age at onset; first-episode psychosis; premorbid functioning; prodrome; schizophrenia