Declining Clinical Course of Psychotic Disorders Over the Two Decades Following First Hospitalization: Evidence From the Suffolk County Mental Health Project
Abstract
Objective:
Method:
Results:
Conclusions:
Method
Participants
Measure | Follow-Up Cohort (N=373) | Nonparticipants (N=176) | ||
---|---|---|---|---|
Demographic characteristics | N | % | N | % |
Male | 222 | 59.5 | 97 | 55.1 |
Age <28 years | 195 | 52.3 | 87 | 49.4 |
Blue-collar household | 165 | 44.2 | 75 | 42.6 |
Caucasianb | 290 | 77.7 | 119 | 67.6 |
Research diagnosis (last available) | ||||
Schizophrenia spectrum disorder | 175 | 46.9 | 73 | 41.5 |
Bipolar I disorder with psychosis | 94 | 25.2 | 41 | 23.3 |
Major depressive disorder with psychosis | 43 | 11.5 | 25 | 14.2 |
Substance-induced psychosis | 25 | 6.7 | 16 | 9.1 |
Other/undetermined psychosis | 36 | 9.7 | 21 | 11.9 |
Baseline ratings | Mean | SD | Mean | SD |
GAF (best month in year before hospitalization) | 58.17 | 14.25 | 59.98 | 14.87 |
Apathy-asociality | 9.38 | 7.61 | 8.90 | 6.21 |
Inexpressivity | 7.32 | 8.08 | 6.28 | 6.98 |
Reality distortionb | 10.73 | 8.71 | 12.78 | 10.39 |
Disorganization | 6.89 | 6.52 | 6.32 | 5.89 |
Depression | 17.52 | 5.38 | 17.22 | 4.93 |
Mania/excitement | 1.66 | 1.16 | 1.53 | 1.07 |
Measures
Data Analysis
Results
Description of Clinical Course
Outcome Measure and Assessment Point | Schizophrenia | Bipolar Disorder With Psychosis | Psychotic Depression | Substance-Induced Psychosis | Other/Undetermined | |||||
---|---|---|---|---|---|---|---|---|---|---|
Mean | SD | Mean | SD | Mean | SD | Mean | SD | Mean | SD | |
GAF | ||||||||||
Baseline | 52.65 | 14.17 | 67.83 | 9.44 | 60.30 | 12.99 | 57.68 | 11.92 | 57.53 | 14.64 |
6 months | 49.34 | 13.18 | 66.37 | 11.90 | 61.45 | 13.94 | 61.74 | 11.45 | 62.73 | 12.67 |
24 months | 50.39 | 12.90 | 69.14 | 10.83 | 64.98 | 12.31 | 64.65 | 11.45 | 60.96 | 14.39 |
48 months | 49.27 | 12.21 | 70.05 | 11.81 | 67.93 | 12.03 | 65.05 | 13.06 | 63.13 | 15.10 |
10 years | 44.06 | 10.67 | 66.95 | 13.14 | 65.61 | 11.72 | 61.39 | 13.99 | 60.93 | 15.49 |
20 years | 35.79 | 10.57 | 57.79 | 16.78 | 52.81 | 16.06 | 53.88 | 16.82 | 51.33 | 19.03 |
Apathy-asociality | ||||||||||
Baseline | 12.11 | 7.36 | 4.95 | 5.74 | 10.67 | 7.60 | 8.40 | 5.61 | 6.86 | 8.26 |
6 months | 11.55 | 7.92 | 5.23 | 6.05 | 8.51 | 7.87 | 7.35 | 4.98 | 5.69 | 7.11 |
24 months | 11.31 | 6.64 | 3.76 | 5.20 | 6.97 | 7.32 | 5.87 | 5.74 | 6.36 | 6.90 |
48 months | 11.30 | 6.70 | 3.70 | 4.67 | 5.67 | 6.88 | 4.47 | 4.90 | 7.67 | 7.12 |
10 years | 13.99 | 8.14 | 3.53 | 4.75 | 4.60 | 5.77 | 7.87 | 7.96 | 6.62 | 8.13 |
20 years | 17.56 | 8.84 | 8.00 | 7.70 | 10.11 | 8.52 | 9.74 | 9.05 | 11.51 | 10.23 |
Inexpressivity | ||||||||||
Baseline | 10.22 | 8.39 | 3.86 | 6.10 | 6.60 | 8.43 | 4.28 | 5.70 | 5.28 | 7.23 |
6 months | 10.52 | 8.92 | 2.64 | 4.79 | 5.00 | 7.09 | 3.30 | 4.20 | 3.92 | 6.58 |
24 months | 9.48 | 8.19 | 1.80 | 2.63 | 3.68 | 5.62 | 3.22 | 5.14 | 2.68 | 4.64 |
48 months | 8.82 | 8.82 | 1.61 | 3.15 | 2.24 | 3.66 | 1.53 | 3.22 | 3.72 | 5.30 |
10 years | 7.99 | 7.67 | 1.68 | 3.98 | 1.87 | 4.15 | 2.40 | 4.57 | 2.83 | 6.49 |
20 years | 10.32 | 10.37 | 3.69 | 5.45 | 4.26 | 7.13 | 4.00 | 6.17 | 7.90 | 11.34 |
Reality distortion | ||||||||||
Baseline | 12.54 | 9.36 | 10.77 | 8.87 | 6.23 | 6.00 | 8.40 | 6.89 | 8.83 | 6.05 |
6 months | 4.26 | 7.44 | 0.56 | 1.29 | 2.81 | 4.56 | 1.52 | 3.19 | 2.50 | 4.67 |
24 months | 4.41 | 6.36 | 0.99 | 3.19 | 0.92 | 2.74 | 1.83 | 3.66 | 3.40 | 6.30 |
48 months | 4.03 | 6.67 | 1.05 | 2.78 | 0.94 | 2.52 | 1.53 | 3.01 | 3.44 | 7.96 |
10 years | 6.66 | 8.24 | 0.46 | 1.86 | 1.03 | 2.29 | 1.78 | 3.25 | 3.07 | 5.69 |
20 years | 7.31 | 9.34 | 0.84 | 2.16 | 0.93 | 2.32 | 2.73 | 4.79 | 3.47 | 5.92 |
Disorganization | ||||||||||
Baseline | 7.19 | 7.00 | 8.97 | 6.05 | 1.86 | 2.96 | 5.68 | 5.37 | 6.89 | 6.07 |
6 months | 2.99 | 5.14 | 1.61 | 3.00 | 0.89 | 1.37 | 0.70 | 1.15 | 2.08 | 2.64 |
24 months | 2.99 | 4.35 | 2.19 | 3.93 | 1.08 | 2.13 | 2.09 | 3.63 | 3.36 | 5.22 |
48 months | 3.65 | 4.87 | 2.34 | 4.22 | 0.73 | 1.86 | 0.47 | 1.02 | 2.33 | 3.07 |
10 years | 4.27 | 6.00 | 1.79 | 3.74 | 0.94 | 2.45 | 1.29 | 2.24 | 3.64 | 6.20 |
20 years | 6.16 | 7.28 | 3.21 | 5.22 | 2.45 | 4.33 | 2.07 | 3.76 | 5.71 | 6.32 |
Depression | ||||||||||
Baseline | 17.04 | 5.02 | 16.85 | 5.13 | 22.21 | 5.23 | 16.96 | 5.83 | 16.42 | 5.10 |
6 months | 13.55 | 4.03 | 12.13 | 3.35 | 15.51 | 5.51 | 12.70 | 3.97 | 13.04 | 5.08 |
24 months | 13.20 | 4.46 | 11.16 | 3.47 | 12.86 | 5.27 | 12.52 | 4.67 | 13.72 | 5.00 |
48 months | 10.69 | 3.79 | 9.94 | 3.07 | 12.00 | 5.72 | 10.53 | 3.42 | 11.72 | 5.38 |
10 years | 11.92 | 3.76 | 10.99 | 3.47 | 13.35 | 5.10 | 12.55 | 4.27 | 11.37 | 3.25 |
20 years | 11.60 | 3.28 | 11.87 | 3.93 | 13.35 | 4.57 | 11.43 | 3.51 | 12.45 | 3.85 |
Mania/excitement | ||||||||||
Baseline | 1.49 | 1.00 | 2.13 | 1.39 | 1.07 | 0.34 | 1.96 | 1.34 | 1.78 | 1.22 |
6 months | 1.21 | 0.66 | 1.44 | 0.90 | 1.00 | 0.00 | 1.26 | 0.75 | 1.20 | 0.71 |
24 months | 1.22 | 0.65 | 1.41 | 0.92 | 1.14 | 0.48 | 1.22 | 0.60 | 1.48 | 1.08 |
48 months | 1.33 | 0.68 | 1.47 | 0.96 | 1.12 | 0.42 | 1.21 | 0.54 | 1.39 | 0.78 |
10 years | 1.29 | 0.80 | 1.35 | 0.90 | 1.15 | 0.48 | 1.57 | 1.20 | 1.59 | 1.37 |
20 years | 1.28 | 0.83 | 1.34 | 0.87 | 1.13 | 0.47 | 1.14 | 0.48 | 1.21 | 0.63 |
N | % | N | % | N | % | N | % | N | % | |
Use of antipsychotics | ||||||||||
Baseline | 152 | 86.9 | 82 | 87.2 | 31 | 72.1 | 15 | 60.0 | 31 | 86.1 |
6 months | 148 | 84.6 | 63 | 67.0 | 24 | 55.8 | 9 | 36.0 | 20 | 55.6 |
24 months | 136 | 79.5 | 37 | 39.4 | 18 | 41.9 | 4 | 16.7 | 14 | 40.0 |
48 months | 122 | 70.1 | 32 | 34.0 | 10 | 23.3 | 4 | 16.0 | 12 | 33.3 |
10 years | 142 | 87.1 | 34 | 40.0 | 8 | 20.0 | 6 | 26.1 | 7 | 25.9 |
20 years | 117 | 81.8 | 30 | 36.1 | 10 | 25.0 | 4 | 20.0 | 10 | 37.0 |
Illness pattern over 20 years | ||||||||||
Single episode | 1 | 0.6 | 10 | 11.4 | 8 | 19.0 | 4 | 17.4 | 10 | 38.5 |
Multiple episodes | 43 | 25.3 | 70 | 79.5 | 28 | 66.7 | 13 | 56.5 | 8 | 30.8 |
Continuous illness | 126 | 74.1 | 8 | 9.1 | 6 | 14.3 | 6 | 26.1 | 8 | 30.8 |
Trajectories of Diagnostic Groups
Measure and Variable | Schizophrenia Group (N=175) | Mood Disorders With Psychosis Group (N=137) | Other Psychoses Group (N=61) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Unadjusted | Adjusted | Unadjusted | Adjusted | Unadjusted | Adjusted | |||||||
B | p | B | p | B | p | B | p | B | p | B | p | |
GAF | ||||||||||||
Time (S1) | –0.70 | <0.001 | –0.59 | <0.001 | 1.52 | <0.001 | 1.26 | <0.001 | 0.49 | 0.119 | 0.60 | 0.097 |
Time (S2) | — | — | — | — | –0.98 | <0.001 | –0.94 | <0.001 | –0.99 | <0.001 | –0.60 | 0.011 |
Age | — | — | –0.10 | 0.231 | — | — | –0.07 | 0.415 | — | — | –0.31 | 0.055 |
Antipsychotics | — | — | –0.84 | 0.480 | — | — | –4.78 | <0.001 | — | — | –5.19 | 0.004 |
Apathy-asociality | ||||||||||||
Time (S1) | 0.34 | <0.001 | 0.26 | <0.001 | –0.59 | <0.001 | –0.58 | <0.001 | 0.22 | <0.001 | 0.05 | 0.571 |
Time (S2) | — | — | 0.48 | <0.001 | 0.40 | <0.001 | — | — | — | — | ||
Age | — | — | 0.09 | 0.133 | — | — | 0.09 | 0.014 | — | — | 0.16 | 0.045 |
Antipsychotics | — | — | 2.59 | 0.001 | — | — | 2.33 | <0.001 | — | — | 1.90 | 0.058 |
Inexpressivity | ||||||||||||
Time (S1) | –0.51 | <0.001 | –0.55 | <0.001 | –0.45 | <0.001 | –0.29 | 0.019 | 0.12 | 0.035 | 0.11 | 0.245 |
Time (S2) | 0.27 | <0.001 | 0.32 | 0.002 | 0.23 | <0.001 | 0.21 | <0.001 | — | — | — | — |
Age | — | — | 0.00 | 0.957 | — | — | –0.02 | 0.453 | — | — | 0.01 | 0.912 |
Antipsychotics | — | — | 2.59 | 0.003 | — | — | 2.04 | <0.001 | — | — | 1.98 | 0.035 |
Reality distortion | ||||||||||||
Time | 0.18 | <0.001 | 0.20 | 0.003 | –0.02 | 0.102 | –0.04 | 0.056 | 0.03 | 0.299 | –0.04 | 0.553 |
Age | — | — | –0.02 | 0.679 | — | — | 0.02 | 0.124 | — | — | 0.07 | 0.208 |
Antipsychotics | — | — | –1.82 | 0.027 | — | — | 0.54 | 0.020 | — | — | 2.24 | 0.001 |
Disorganization | ||||||||||||
Time | 0.18 | <0.001 | 0.18 | 0.001 | 0.07 | <0.001 | 0.05 | 0.064 | 0.11 | 0.001 | 0.03 | 0.602 |
Age | — | — | –0.01 | 0.875 | — | — | 0.02 | 0.393 | — | — | 0.07 | 0.146 |
Antipsychotics | — | — | –1.65 | 0.005 | — | — | 0.00 | 0.990 | — | — | –0.05 | 0.939 |
Depression | ||||||||||||
Time (S1) | –0.10 | <0.001 | –0.08 | 0.016 | –0.99 | 0.001 | –0.89 | 0.002 | –0.06 | 0.065 | –0.15 | 0.007 |
Time (S2) | — | — | — | — | 0.03 | 0.166 | 0.00 | 0.969 | — | — | — | — |
Age | — | — | –0.02 | 0.466 | — | — | 0.04 | 0.130 | — | — | 0.08 | 0.056 |
Antipsychotics | — | — | 0.72 | 0.088 | — | — | 0.83 | 0.033 | — | — | 1.49 | 0.019 |
Mania/excitement | ||||||||||||
Time | 0.00 | 0.313 | 0.01 | 0.149 | 0.00 | 0.696 | 0.00 | 0.887 | 0.00 | 0.889 | –0.01 | 0.368 |
Age | — | — | –0.01 | 0.291 | — | — | 0.00 | 0.549 | — | — | 0.01 | 0.332 |
Antipsychotics | — | — | –0.20 | 0.009 | — | — | 0.09 | 0.229 | — | — | 0.02 | 0.896 |
Discussion
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