Persistent Psychosis During 4 Years after First Hospitalization for a Psychotic Disorder in the Suffolk County Mental Health Project: Prevalence, Risk Factors, and Relationship to 25-Year Outcomes

BACKGROUND AND HYPOTHESIS: The early phase of psychosis is critical for interventions to modify long-term outcomes. It is unclear what proportion of individuals' exhibit early persistent psychosis and the long-term implications. STUDY DESIGN: An epidemiologic sample of individuals with acute psychosis was recruited at first admission and followed for 25 years. Early persistent psychosis was defined as presence of active psychosis for ≥90% of the days of the 4 years after first hospitalization for psychosis. Multivariable regression analyses were conducted, testing the association between baseline predictors and persistent psychosis, and between persistent psychosis and 25-year outcomes. STUDY RESULTS: Out of 526 individuals (age = 27. 4 ± 9. 4 years, males = 56. 8%, baseline schizophrenia/schizoaffective disorder = 30. 0%), 101 (19. 2%) had early persistent psychosis. At baseline, low premorbid cognitive performance (odds ratio (OR) = 2. 08, 95% CI, 1. 05-4. 12), lower Global Assessment of Functioning (OR = 1. 59, 95% CI, 1. 16-2. 13), low role function (OR = 1. 49, 95% CI, 1. 03-2. 16) and worse social function (OR = 1. 52, 95% CI, 1. 03-2. 22) were predictive of persistent psychosis. At 25-year follow-up (n = 307, 58. 9%), early persistent psychosis was associated with worse avolition (=0. 25, 95% CI, 0. 14-0. 35), more severe reality distortion (=0. 19, 95% CI, 0. 07-0. 31), disorganization (=0. 21, 95% CI, 0. 09-0. 32), worse social (=-0. 18, 95% CI, -0. 06 to -0. 30), role (=-0. 22, 95% CI, -0. 09 to -0. 34), and global function (=-0. 28, 95% CI, -0. 17 to -0. 38), greater odds of being on public assistance (OR = 2. 13, 95% CI, 1. 15-3. 95), lower odds of living independently (OR = 0. 43, 95% CI, 0. 23-0. 80) or recovery (OR = 0. 09, 95% CI, 0. 02-0. 38). CONCLUSIONS: One in 5 individuals with first-episode psychosis had early persistent psychosis without clearly modifiable premorbid factors, and with strong associations with adverse long-term outcomes. Individuals experiencing early persistent psychosis require focused long-term interventions.