Declining Clinical Course of Psychotic Disorders Over the Two Decades Following First Hospitalization: Evidence From the Suffolk County Mental Health Project
Autor: | Kaiqiao Li, Marsha Tanenberg-Karant, Gabrielle A. Carlson, Laura J. Fochtmann, Eva Velthorst, Roman Kotov, Greg Perlman, Eduardo Constantino, Evelyn J. Bromet, Anne-Kathrin Fett, Joan Rubinstein |
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Rok vydání: | 2017 |
Předmět: |
Adult
Male medicine.medical_specialty Psychosis Bipolar Disorder Adolescent Global Assessment of Functioning New York Schizoaffective disorder behavioral disciplines and activities Severity of Illness Index 03 medical and health sciences Young Adult 0302 clinical medicine mental disorders medicine Humans Prospective Studies Psychiatry First episode Depressive Disorder Major Depression Middle Aged medicine.disease Mental health 030227 psychiatry Hospitalization Psychiatry and Mental health Mood Psychotic Disorders Schizophrenia Cohort Disease Progression Female Schizophrenic Psychology Psychology 030217 neurology & neurosurgery Clinical psychology Follow-Up Studies |
Zdroj: | The American journal of psychiatry. 174(11) |
ISSN: | 1535-7228 0002-953X |
Popis: | OBJECTIVE: Kraepelin considered declining course a hallmark of schizophrenia, but others have suggested that outcomes usually stabilize or improve after treatment initiation. The authors investigated this question in an epidemiologically defined cohort with psychotic disorders followed for 20 years after first hospitalization. METHOD: The Suffolk County Mental Health Project recruited first-admission patients with psychosis from all inpatient units of Suffolk County, New York (response rate, 72%). Participants were assessed in person six times over two decades; 373 completed the 20-year follow-up (68% of survivors); 175 had schizophrenia/schizoaffective disorder. Global Assessment of Functioning (GAF), psychotic symptoms, and mood symptoms were rated at each assessment. Month 6, when nearly all participants were discharged from the index hospitalization, was used as a reference. RESULTS: In the schizophrenia group, mean GAF scores declined from 49 at month 6 to 36 at year 20. Negative and positive symptoms also worsened (Cohen's d values, 0.45-0.73). Among participants without schizophrenia, GAF scores were higher initially (a mean of approximately 64) but declined by 9 points over the follow-up period. Worsening began between years 5 and 8. Neither aging nor changes in antipsychotic treatment accounted for the declines. In all disorders, depression improved and manic symptoms remained low across the 20 years. CONCLUSIONS: The authors found substantial symptom burden across disorders that increased with time and ultimately may undo initial treatment gains. Previous studies have suggested that better health care delivery models may preempt this decline. In the United States, these care needs are often not met, and addressing them is an urgent priority. |
Databáze: | OpenAIRE |
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