Long-Term Morbidity in Major Affective and Schizoaffective Disorders Following Hospitalization in First Psychotic Episodes

Paola Salvatore, MD

McLean Hospital
Long-Term Morbidity in Major Affective and Schizoaffective Disorders Following Hospitalization in First Psychotic Episodes

Scientific Abstract

Background: Studies following patients from first-psychotic episodes have been instructive concerning diagnostic stability, clinical responses, initial recovery, future illness course, functional outcomes, and their prediction. Most of this research focused on schizophrenia-like disorders while very few studies followed psychotic mood-disorder patients prospectively from a first-lifetime hospitalization for psychosis over several years, with detailed recording of their clinical status and longitudinal morbidity.

Methods: We followed adult subjects systematically at regular intervals from hospitalization for first-lifetime episodes of major affective and schizoaffective disorders with initial psychotic features. We compiled %-of-days with morbidity-types from detailed records and life-charts, reviewed earliest antecedent morbidities, compared both with final diagnoses and initial presenting illness-types, and evaluated morbidity risk-factors with regression modeling.

Results: With final diagnoses of bipolar-I (BD-I, n=216), schizoaffective (SzAffD, 71), and major depressive (MDD, 42) disorders, 329 subjects were followed for 4.47 [CI: 4.20–4.47] years. Initial episodes were: mania (41.6%), mixed-states (24.3%), depression (19.5%), or apparent nonaffective psychosis (14.6%). Antecedent morbidity presented 12.7 years before first-episodes (ages: SzAffD≤BD-I<MDD). Long-term %-of- days-ill ranked: SzAffD (83.0%), MDD (57.8%), and BD-I (45.0%). Morbidity differed by final diagnosis and first-episode types, was predicted by first-episodes, and suggested by antecedent illnesses. Long-term wellness was greater with: BD-I diagnosis, first- episode not mixed or psychotic-nonaffective, rapid-onset, and being older at first antecedents, but not follow-up duration.

Conclusions: Initially psychotic BD-I, SzAffD, or MDD subjects followed for 4.47 years from first-hospitalization experienced much illness, especially depressive or dysthymic, despite ongoing clinical treatment. Antecedent symptoms arose years before index first- episodes; antecedents and first-episode types predicted types and amounts of long-term morbidity, which ranked: SzAffD > MDD > BD-I.

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research Areas


Paola Salvatore, MD, Harimandir K. Khalsa, Ms, Mauricio Tohen, MD, DrPH, MBA, Ross J. Baldessarini, MD

Principal Investigator

Mauricio Tohen, MD, DrPH, MBA