Subtyping first-episode non-affective psychosis using four early-course features: Potentially useful prognostic information at initial presentation

• Type of Material: Article
• Authors: Mary Kelley, Emory University; Michael T. Compton, George Washington University; Dawn Flosnik Ionescu, National Institute of Mental Health, Bethesda
• Language: English
• Date: 2014-01-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 Wiley Publishing Asia Pty Ltd.
• Final Published Version (URL): http://dx.doi.org/10.1111/eip.12026
• Title of Journal or Parent Work: Early Intervention in Psychiatry
• ISSN: 1751-7885
• Volume: 8
• Issue: 1
• Start Page: 50
• End Page: 58
• Grant/Funding Information: This research was supported by grants K23 MH067589 and R01 MH081011 to the first author from the National Institute of Mental Health (NIMH).
• Keywords: premorbid functioning; Psychotic Disorders; Male; Social Behavior; Early Diagnosis; Adolescent; Female; Prognosis; prodrome; age at onset; Young Adult; Educational Status; schizophrenia; Prodromal Symptoms; Age of Onset; first-episode psychosis; Adult; Humans
• Research Categories: Psychology, Cognitive; Psychology, Behavioral; Health Sciences, Medicine and Surgery

Abstract

Aim: Heterogeneity of symptoms, course and outcomes in primary psychotic disorders complicates prognosis, treatment and diverse aspects of research. This study aimed to identify interpretable subtypes of first-episode non-affective psychosis based on four early-course features (premorbid academic functioning, premorbid social functioning, duration of the prodrome and age at onset of psychosis). Methods: Data from 200 well-characterized patients hospitalized in public-sector inpatient units for first-episode non-affective psychosis were used in latent profile analyses. Derived subtypes were then compared along a number of clinical dimensions using analyses of variance. Results: Using four early-course features, three classes were derived. A good premorbid/short prodrome subtype was characterized by a lower severity of positive symptoms, better social/occupational/global functioning, and a shorter duration of untreated psychosis; a poor premorbid/early onset subtype demonstrated greater negative and preoccupation symptoms, as well as greater psychosocial problems; and a long prodrome/late onset subtype was characterized by greater dysphoric symptoms. Conclusions: Findings indicate a need for further research with first-episode samples on the utility of subtyping based on early-course (premorbid, prodromal and onset-related) characteristics. Such efforts could enhance the parsing of heterogeneity, thereby advancing clinical practice and research.