Predicting 5-Year Outcome in First-Episode Psychosis: Construction of a Prognostic Rating Scale 

Lena Flyckt, M.D., Ph.D.; Maria Mattsson, M.Sc.; Gunnar Edman, Ph.D.; Roger Carlsson, M.Sc.; and Johan Cullberg, M.D., Ph.D.

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 regression model.

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.

(J Clin Psychiatry 2006;67:916-924)

Received June 10, 2005; accepted Nov. 14, 2005. From the Department of Psychiatry, Research and Development Section, Karolinska Institutet, Danderyd Hospital, Stockholm (Drs. Flyckt, Edman, and Cullberg and Ms. Mattsson); and the Department of Psychology, Lund University, Lund (Mr. Carlsson), Sweden.

The study was financially supported by grants from the Vårdal Foundation (Dr. Cullberg) and the Stockholm County Council (EXPO) (Dr. Flyckt).

The results have not been presented or published elsewhere.

The authors report no financial or other affiliation relevant to the subject of this article.

Corresponding author and reprints: Lena Flyckt, M.D., Ph.D., Department of Psychiatry, Research and Development Section, Danderyd Hospital, S-182 87 Danderyd, Sweden (e-mail: lena.flyckt@ki.se).