Two-year outcomes and predictors in first-episode psychotic patients treated in community mental health services. Findings from the PICOS project

Background/Objectives: (1) To describe 2-year outcomes in a large clinical epidemiologic cohort of first-episode psychosis (FEP) patients, and (2) to explore the relative weight of premorbid adjustment (PA), duration of untreated psychosis (DUP), mode of onset, clinical and social characteristics at onset in predicting 2-year outcome.

Methods: This study was conducted in the context of the Psychosis Incident Cohort Outcome Study (PICOS), a multisite naturalistic research on FEP patients treated within the public psychiatric sector in the Veneto Region (Italy) and which aims to develop a comprehensive predictive model of outcome in FEP patients, by integrating clinical, social, genetic and MRI data. The PICOS covers a broad catchment area (3.8 million inhabitants) of the Veneto Region (Italy), one of the largest ever reported in the literature. A set of international standardised assessment measures were used.

Results: At baseline, 501 patients were recruited over a three years period; of these, 350 (55%male, age M=32 years; SD=9.5), with ICD-10 diagnosis of schizophrenia (24%), non affective psychosis (55%) and affective psychosis (21%), were assessed. PA was at least moderately impaired in 40%, with schizophrenics being more compromised than others. The median DUP was 5 weeks, without significant differences between groups. DUP and PA were not correlated, whereas longer DUP and worse PA were both independently correlated (r=0.20; p<0.05) with higher negative symptoms and more social disability at baseline. Substantial clinical and social improvements occurred over 2-year follow-up. Longer DUP, worse PA and high negative symptoms at baseline predicted higher negative symptoms and social disability at 2-year follow-up. When diagnosis was entered, the greatest part of the variance was accounted for being diagnosed with schizophrenia.

Discussion/Conclusions: The modest variance in outcome explained by premorbid adjustment and duration of untreated psychosis, and the lack of reciprocal correlation, suggest a potentially important role of other latent mediating variables, such as those embedded within the broader concept of diagnosis. These could be the reflection of the underlying neurobiological deficit processes of psychoses. More finely tuned analyses are needed to address this important issue, together with a deeper understanding of the environmental and biological factors influencing the onset and course of psychosis.

Funding: Grants from Fondazione Cariverona to Prof. Tansella; from the Ministry of Health, Ricerca Sanitaria Finalizzata 2004 to Prof. Ruggeri; and from the Ministry of Health, Ricerca Sanitaria Finalizzata 2005 to Dr. Lasalvia.

Keywords: First-episode psychosis, duration of untreated psychosis, premorbid adjustment.