Involuntary Treatment in First-Episode Psychosis and Mania: A Retrospective Population-Based Cohort Study

OBJECTIVE: The study aimed to examine how involuntary status at first presentation affects 5-year trajectories of first-episode psychosis or first-episode mania (FEP/FEM). METHODS: The authors conducted a population-based cohort study on FEP/FEM. Legal status at first episode was classified as involuntary or voluntary. Participants were followed up to 5 years to examine relapse, emergency department use, vocational status, and Social and Occupational Functioning Assessment Scale (SOFAS) scores. Relapse was compared by using log-rank tests; repeated-measures outcomes used mixed-effects models that adjusted for age and sex, with linear, logistic, or negative binomial regression as appropriate. RESULTS: The cohort included 200 individuals (voluntary, N=139; involuntary, N=61). The involuntary group was older than the voluntary group (p<0.001) and had greater illness severity (Clinical Global Impressions-Severity mean=5.5 vs. 5.1, p=0.002) at FEP/FEM. Time to relapse did not differ, nor did emergency department visits or psychiatric hospitalizations. Functioning improved at a similar rate in both groups; however, the involuntary group remained lower in functioning (SOFAS mean difference=-5.9, p=0.007) and had higher odds of being vocationally disengaged throughout follow-up (odds ratio=3.82, p=0.009). CONCLUSIONS: The authors found that involuntary treatment at FEP/FEM is common and is characterized by greater baseline illness severity. Involuntary status can serve as an entry point into care without excess long-term service utilization, and both groups showed similar rates of functional improvement. Persistently lower functioning and higher odds of vocational disengagement in the involuntary group support the need for targeted vocational interventions.