Three-year outcome of first-episode psychoses in an established community psychiatric service

Abstract

Background: Changes in service provision, secular trends in substance misuse and changing social structures might affect outcome in psychosis. Aims: To assess the three-year outcome of an inception cohort of first- episode psychoses treated in a modern, community-oriented service; to compare outcomes with an earlier cohort treatment in hospital-based care; and to examine the predictive validity of ICD-10 diagnostic criteria. Method: Three- year follow-up (1995-1997) of an inception cohort of first-episode psychoses and comparison with two-year follow-up (1980-1982) of the Determinants of Outcome of Severe Mental Disorders (DOSMED) Nottingham cohort. Results: On most outcome measures, non-affective psychoses had a worse outcome than affective psychoses. Affective psychoses had better outcome than previously reported. Substance-related psychoses had very poor occupational outcome. Similar proportions of the current and DOSMED cohort were in remission but the former were rated as having greater disability. Conclusions: In a modern community service, 30-60% of patients with first-episode psychoses experience a good three-year outcome. The ICD-10 criteria have good predictive validity. Declaration of interest: Funded by NHS Executive Trent R and D and the Stanley Foundation. T.C. was supported by the Medical Research Council.