PMID- 28774193 OWN - NLM STAT- MEDLINE DCOM- 20171107 LR - 20240213 IS - 1535-7228 (Electronic) IS - 0002-953X (Print) IS - 0002-953X (Linking) VI - 174 IP - 11 DP - 2017 Nov 1 TI - Declining Clinical Course of Psychotic Disorders Over the Two Decades Following First Hospitalization: Evidence From the Suffolk County Mental Health Project. PG - 1064-1074 LID - 10.1176/appi.ajp.2017.16101191 [doi] AB - 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. FAU - Kotov, Roman AU - Kotov R AD - From the Department of Psychiatry, Stony Brook University, Stony Brook, N.Y.; the Department of Psychiatry and the Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York; the Department of Educational Neuroscience and Research Institute LEARN, Faculty of Psychology and Education, VU University, Amsterdam; and the Department of Psychosis Studies, Institute of Psychiatry, King's College London. FAU - Fochtmann, Laura AU - Fochtmann L AD - From the Department of Psychiatry, Stony Brook University, Stony Brook, N.Y.; the Department of Psychiatry and the Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York; the Department of Educational Neuroscience and Research Institute LEARN, Faculty of Psychology and Education, VU University, Amsterdam; and the Department of Psychosis Studies, Institute of Psychiatry, King's College London. FAU - Li, Kaiqiao AU - Li K AD - From the Department of Psychiatry, Stony Brook University, Stony Brook, N.Y.; the Department of Psychiatry and the Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York; the Department of Educational Neuroscience and Research Institute LEARN, Faculty of Psychology and Education, VU University, Amsterdam; and the Department of Psychosis Studies, Institute of Psychiatry, King's College London. FAU - Tanenberg-Karant, Marsha AU - Tanenberg-Karant M AD - From the Department of Psychiatry, Stony Brook University, Stony Brook, N.Y.; the Department of Psychiatry and the Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York; the Department of Educational Neuroscience and Research Institute LEARN, Faculty of Psychology and Education, VU University, Amsterdam; and the Department of Psychosis Studies, Institute of Psychiatry, King's College London. FAU - Constantino, Eduardo A AU - Constantino EA AD - From the Department of Psychiatry, Stony Brook University, Stony Brook, N.Y.; the Department of Psychiatry and the Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York; the Department of Educational Neuroscience and Research Institute LEARN, Faculty of Psychology and Education, VU University, Amsterdam; and the Department of Psychosis Studies, Institute of Psychiatry, King's College London. FAU - Rubinstein, Joan AU - Rubinstein J AD - From the Department of Psychiatry, Stony Brook University, Stony Brook, N.Y.; the Department of Psychiatry and the Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York; the Department of Educational Neuroscience and Research Institute LEARN, Faculty of Psychology and Education, VU University, Amsterdam; and the Department of Psychosis Studies, Institute of Psychiatry, King's College London. FAU - Perlman, Greg AU - Perlman G AD - From the Department of Psychiatry, Stony Brook University, Stony Brook, N.Y.; the Department of Psychiatry and the Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York; the Department of Educational Neuroscience and Research Institute LEARN, Faculty of Psychology and Education, VU University, Amsterdam; and the Department of Psychosis Studies, Institute of Psychiatry, King's College London. FAU - Velthorst, Eva AU - Velthorst E AD - From the Department of Psychiatry, Stony Brook University, Stony Brook, N.Y.; the Department of Psychiatry and the Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York; the Department of Educational Neuroscience and Research Institute LEARN, Faculty of Psychology and Education, VU University, Amsterdam; and the Department of Psychosis Studies, Institute of Psychiatry, King's College London. FAU - Fett, Anne-Kathrin J AU - Fett AJ AD - From the Department of Psychiatry, Stony Brook University, Stony Brook, N.Y.; the Department of Psychiatry and the Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York; the Department of Educational Neuroscience and Research Institute LEARN, Faculty of Psychology and Education, VU University, Amsterdam; and the Department of Psychosis Studies, Institute of Psychiatry, King's College London. FAU - Carlson, Gabrielle AU - Carlson G AD - From the Department of Psychiatry, Stony Brook University, Stony Brook, N.Y.; the Department of Psychiatry and the Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York; the Department of Educational Neuroscience and Research Institute LEARN, Faculty of Psychology and Education, VU University, Amsterdam; and the Department of Psychosis Studies, Institute of Psychiatry, King's College London. FAU - Bromet, Evelyn J AU - Bromet EJ AD - From the Department of Psychiatry, Stony Brook University, Stony Brook, N.Y.; the Department of Psychiatry and the Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York; the Department of Educational Neuroscience and Research Institute LEARN, Faculty of Psychology and Education, VU University, Amsterdam; and the Department of Psychosis Studies, Institute of Psychiatry, King's College London. LA - eng GR - R01 MH044801/MH/NIMH NIH HHS/United States GR - R01 MH094398/MH/NIMH NIH HHS/United States GR - R01 MH110434/MH/NIMH NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20170804 PL - United States TA - Am J Psychiatry JT - The American journal of psychiatry JID - 0370512 SB - IM CIN - Am J Psychiatry. 2017 Nov 1;174(11):1030-1031. PMID: 29088932 MH - Adolescent MH - Adult MH - Bipolar Disorder/*psychology MH - Depression/psychology MH - Depressive Disorder, Major/*psychology MH - *Disease Progression MH - Female MH - Follow-Up Studies MH - Hospitalization MH - Humans MH - Male MH - Middle Aged MH - New York MH - Prospective Studies MH - Psychotic Disorders/*psychology MH - *Schizophrenia MH - *Schizophrenic Psychology MH - Severity of Illness Index MH - Young Adult PMC - PMC5767161 MID - NIHMS888917 OTO - NOTNLM OT - Bipolar Disorder Longitudinal OT - Epidemiology OT - First Episode OT - Outcome Studies OT - Psychosis EDAT- 2017/08/05 06:00 MHDA- 2017/11/08 06:00 PMCR- 2018/05/01 CRDT- 2017/08/05 06:00 PHST- 2017/08/05 06:00 [pubmed] PHST- 2017/11/08 06:00 [medline] PHST- 2017/08/05 06:00 [entrez] PHST- 2018/05/01 00:00 [pmc-release] AID - 10.1176/appi.ajp.2017.16101191 [doi] PST - ppublish SO - Am J Psychiatry. 2017 Nov 1;174(11):1064-1074. doi: 10.1176/appi.ajp.2017.16101191. Epub 2017 Aug 4.