The McLean-Harvard First-Episode Project: Early Course in 114 Cases of First-Episode Nonaffective Psychoses

Mauricio Tohen, MD, DrPH, MBA; Hari-Mandir K. Khalsa, MS; Paola Salvatore, MD; Carlos A. Zarate Jr, MD; Stephen M. Strakowski, MD; Jesús Pérez Sanchez-Toledo, MD, PhD; and Ross J. Baldessarini, MD

Published: June 22, 2016

Article Abstract

Background: Early course in contemporary, clinically treated, nonaffective psychotic disorders other than schizophrenia remains incompletely defined.

Methods: We prospectively, repeatedly, and systematically assessed 114 patients hospitalized for a first episode of DSM-IV-TR nonaffective psychotic illness for 2 years (19891996) 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.

Results: 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%).

Conclusions: 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.

Volume: 77

Quick Links: Psychotic Disorders , Schizophrenia and Schizoaffective Disorders

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