Persistent Psychosis During 4 Years after First Hospitalization for a Psychotic Disorder in the Suffolk County Mental Health Project: Prevalence, Risk Factors, and Relationship to 25-Year Outcomes.

BACKGROUND AND HYPOTHESIS: The early phase of psychosis is critical for interventions to modify long-term outcomes. It is unclear what proportion of individuals' exhibit early persistent psychosis and the long-term implications.

STUDY

DESIGN

An epidemiologic sample of individuals with acute psychosis was recruited at first admission and followed for 25 years. Early persistent psychosis was defined as presence of active psychosis for ≥90% of the days of the 4 years after first hospitalization for psychosis. Multivariable regression analyses were conducted, testing the association between baseline predictors and persistent psychosis, and between persistent psychosis and 25-year outcomes.

STUDY

RESULTS

Out of 526 individuals (age = 27.4 ± 9.4 years, males = 56.8%, baseline schizophrenia/schizoaffective disorder = 30.0%), 101 (19.2%) had early persistent psychosis. At baseline, low premorbid cognitive performance (odds ratio (OR) = 2.08, 95% CI, 1.05-4.12), lower Global Assessment of Functioning (OR = 1.59, 95% CI, 1.16-2.13), low role function (OR = 1.49, 95% CI, 1.03-2.16) and worse social function (OR = 1.52, 95% CI, 1.03-2.22) were predictive of persistent psychosis. At 25-year follow-up (n = 307, 58.9%), early persistent psychosis was associated with worse avolition ($\beta$=0.25, 95% CI, 0.14-0.35), more severe reality distortion ($\beta$=0.19, 95% CI, 0.07-0.31), disorganization ($\beta$=0.21, 95% CI, 0.09-0.32), worse social ($\beta$=-0.18, 95% CI, -0.06 to -0.30), role ($\beta$=-0.22, 95% CI, -0.09 to -0.34), and global function ($\beta$=-0.28, 95% CI, -0.17 to -0.38), greater odds of being on public assistance (OR = 2.13, 95% CI, 1.15-3.95), lower odds of living independently (OR = 0.43, 95% CI, 0.23-0.80) or recovery (OR = 0.09, 95% CI, 0.02-0.38).

CONCLUSIONS

One in 5 individuals with first-episode psychosis had early persistent psychosis without clearly modifiable premorbid factors, and with strong associations with adverse long-term outcomes. Individuals experiencing early persistent psychosis require focused long-term interventions.