Predicting 5-Year Outcome in First-Episode Psychosis: Construction of a Prognostic Rating Scale.
J Clin Psychiatry 2006;67:916-924
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: The aim of this study was to
construct a rating scale to predict long-term
outcome on the basis of clinical and
sociodemographic characteristics in patients with symptoms of
psychosis who seek psychiatric help for the first time.
Method: Patients (N = 153) experiencing
their first episode of psychosis (DSM-IV
schizophrenia, schizophreniform disorder,
schizoaffective disorder, brief psychotic episode, delusional
disorder, affective psychosis with
mood-incongruent delusions, or psychotic disorder not
otherwise specified or being actively psychotic) were
consecutively recruited from 17 psychiatric clinics
in Sweden from January 1996 through December 1997 (24 months). Baseline characteristics
were assessed with an extensive battery of
psychiatric rating scales; duration of untreated
psychosis, premorbid characteristics, and cognitive
functioning were also assessed. The relationship
between baseline characteristics and the 5-year
outcome was analyzed using a stepwise logistic
Results: In the logistic regression analysis,
5 variables were found to have unique
contributions in the prediction of outcome. In order of
magnitude of the odds ratios, these variables were Global Assessment of Functioning (GAF)
score during the year before first admission,
education level, actual GAF score at first admission,
gender, and social network. The sensitivity, i.e.,
correctly identified cases (poor outcome), was 0.84,
and the specificity, i.e., the correctly identified
noncases (good outcome), was 0.77.
Conclusion: To initiate adequate
interventions, it is crucial to identify patients
experiencing their first episode of psychosis who are likely
to have an unfavorable long-term outcome. The predictive rating scale described here is a
feasible tool for early detection of these patients.