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First-episode psychosis

What are outcomes for people with first-episode psychosis or high-risk mental states?

After being identified as having high-risk mental states, or after an initial diagnosis of psychosis, relevant outcomes over the years following include transition to psychosis or schizophrenia, symptom severity, recovery and remission, relapse, employment, functioning, relationships, and quality of life. Investigating these outcomes and the factors influencing them provides insight into early treatment strategies.

What is the evidence for outcomes in people with first-episode psychosis or high-risk mental states?

Moderate quality evidence suggests up to 80% of people have good or intermediate outcomes following a first episode of psychosis (follow-up was for 3 years). Positive outcomes include lack of relapse or rehospitalisation, more employment, more insight and clarity, and improved relationships with family and friends. Predictors of good outcomes include being treated with a combination of pharmacotherapy and psychosocial therapy, and being from a developing rather than a developed country. Predictors of poor outcome include being treatment-naive, being medicated with first generation rather than second generation antipsychotics, and having depressive symptoms.

For people with first-episode psychosis or schizophrenia and a current substance use disorder, moderate to high quality evidence suggests worse positive and depressive symptoms, and worse global functioning compared to people with first-episode psychosis or schizophrenia and a former, or no history of a substance use disorder. Moderate quality evidence also suggests an increased risk of relapse, re-hospitalisation, and treatment non-adherence, particularly if using cocaine, opiates, or ecstasy.

Moderate quality evidence indicates the average risk of transition to full psychotic episode in people at high clinical risk of psychosis is ~24-29%. Studies assessing psychosocial treatments or antipsychotics reported lower transition rates than studies assessing standard care or no antipsychotics. People with brief, limited or intermittent psychotic symptoms have higher transition rates to full psychosis than people with attenuated or milder psychotic symptoms, who in turn have higher transition rates than people with genetic vulnerability and a marked decline in functioning. Neurocognitive deficits, negative and disorganisation subclinical symptoms, but not positive subclinical symptoms, are associated with poor functioning in people with high-risk mental states.

August 2020

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Last updated at: 2:16 pm, 15th February 2022
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