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Stephen M. Strakowski, MD; Paul E. Keck, Jr, MD; Susan L. McElroy, MD; Scott A. West, MD; Kenji W. Sax, PhD; John M. Hawkins, MD; Geri F. Kmetz, MSW; Vidya H. Upadhyaya, MD; Karen C. Tugrul, RN; Michelle L. Bourne

Arch Gen Psychiatry. 1998;55:49-55.

Background  We studied the 12-month course of illness after a first hospitalization for affective psychosis to identify potential outcome predictors in this rarely studied patient population.

Methods  For this study, 109 patients consecutively admitted for their first psychiatric hospitalization for treatment of affective psychosis were recruited. Diagnostic, symptomatic, and functional evaluations were obtained at the index hospitalization and at 2, 6, and 12 months after discharge to assess syndromic, symptomatic, and functional outcome predictors. Factors associated with outcome were identified by means of multivariate analyses.

Results  Fifty-six percent of the patients achieved syndromic recovery during the 12-month follow-up. Full treatment compliance was associated with more frequent and rapid syndromic recovery. Full compliance was more common in white patients and in patients without substance abuse. Only 35% of these patients achieved symptomatic recovery during this same 12-month interval, and, similarly, only 35% achieved functional recovery. Symptomatic recovery was delayed in patients with substance abuse and was associated with higher socioeconomic status. Higher socioeconomic status was also associated with functional recovery, as was good premorbid function.

Conclusions  Few patients achieved a favorable outcome in the year after a first hospitalization for an affective psychosis. Low socioeconomic status, poor premorbid function, treatment noncompliance, and substance abuse were associated with lower rates or delayed onset of recovery.

From the Psychotic Disorders Research (Drs Strakowski, West, Sax, Hawkins, and Upadhyaya and Ms Bourne) and Biological Psychiatry Programs (Drs Keck, McElroy, and Kmetz and Ms Tugrul), Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio.

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