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

Abstract

BackgroundChanges in service provision, secular trends in substance misuse and changing social structures might affect outcome in psychosis.AimsTo 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 treated in hospital-based care; and to examine the predictive validity of ICD–10 diagnostic criteria.MethodThree-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.ResultsOn 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.ConclusionsIn 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.