title: The McLean-Harvard First-Episode Project: Early Course in 114 Cases of First-Episode Nonaffective Psychoses.
abstract: Early course in contemporary, clinically treated, nonaffective psychotic disorders other than schizophrenia remains incompletely defined.
  
  
  
  We prospectively, repeatedly, and systematically assessed 114 patients hospitalized for a first episode of DSM-IV-TR nonaffective psychotic illness for ≥ 2 years (1989-1996) using structured (Structured Clinical Interview for DSM-III-R, Patient Edition; Clinical Global Impressions scale; Scale for the Assessment of Negative Symptoms; Scale for the Assessment of Positive Symptoms; and the expanded version of the Brief Psychiatric Rating Scale) and unstructured (best-estimate procedure, life charting) naturalistic follow-up procedures and survival analysis.
  
  
  
  Duration of untreated psychosis (22 ± 38 months) was longest with schizophrenia. Within 2 years, syndromal remission sustained for ≥ 8 weeks (recovery) was attained by 75 subjects (65.8%); median latency to syndromal recovery was 9.4 (95% CI, 5.7-13.3) weeks and was shorter with cycloid features, initial diagnosis of brief psychosis or schizophreniform disorder, and shorter initial hospitalization. Functional recovery within 2 years was achieved by 28 of 68 subjects (41.2%), more often without initial mood-psychomotor instability or homicidal ideation. New episodes occurred in 52 of 114 subjects (45.6%) and were more likely with less affective flattening, younger age, and white race. Median time to new episodes (43.7 [27.9-70.6] weeks) was earlier with initial first-rank auditory hallucinations, substance abuse, and functional nonrecovery. Diagnosis changed to other nonaffective, schizoaffective, or affective disorders within 2 years in 62 of 108 cases (57.4%).
  
  
  
  Three-quarters of patients presenting in first lifetime, nonaffective psychotic episodes achieved recovery within 2 years, but only 41% returned to baseline functioning, and nearly half experienced new episodes. Patients with schizophrenia had the longest duration of untreated psychosis. A majority changed diagnosis, indicating instability of some DSM psychotic-disorder diagnoses.
authors.affiliation: Department of Psychiatry, University of New Mexico Health Sciences Center, 2400 Tucker Ave, Albuquerque, NM 87131. mtohen@salud.unm.edu.|Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.|International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital and Harvard Medical School, Boston, Massachusetts, USA.|Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Tohen
authors.affiliation: International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Hari-Mandir K
authors.initials: HM
authors.lastname: Khalsa
authors.affiliation: International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital and Harvard Medical School, Boston, Massachusetts, USA.|Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.|Psychiatry Section, Department of Neuroscience, School of Medicine, University of Parma, Parma, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Salvatore
authors.affiliation: National Institute of Mental Health, Bethesda, Maryland, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Zarate
authors.affiliation: Department of Psychiatry, University of Cincinnati, Cincinnati, Ohio, USA.|Department of Psychiatry, Dell Medical School, The University of Texas at Austin (current affiliation).
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Strakowski
authors.affiliation: Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Jesús Pérez
authors.initials: JP
authors.lastname: Sanchez-Toledo
authors.affiliation: International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital and Harvard Medical School, Boston, Massachusetts, USA.|Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Baldessarini
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006708:Homicide / Q000523:psychology / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D008297:Male; D008404:Massachusetts; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D012008:Recurrence; D012559:Schizophrenia / Q000175:diagnosis* / Q000628:therapy; D012563:Schizophrenia, Paranoid / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D012565:Schizophrenic Psychology; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D016896:Treatment Outcome