Abstract
Objective
Evaluate morbidity during long‐term follow‐up with clinical treatment of affective and schizoaffective disorder subjects followed from hospitalization for first major psychotic episodes.
Methods
We followed adult subjects systematically at regular intervals from hospitalization for first‐lifetime episodes of major affective and schizoaffective disorders with initial psychotic features. We compiled %‐of‐days with morbidity‐types from detailed records and life‐charts, reviewed earliest antecedent morbidities, compared both with final diagnoses and initial presenting illness‐types, and evaluated morbidity risk‐factors with regression modeling.
Findings
With final diagnoses of bipolar‐I (BD‐I, n=216), schizoaffective (SzAffD, 71), and major depressive (MDD, 42) disorders, 329 subjects were followed for 4.47 [CI: 4.20–4.47] years. Initial episodes were: mania (41.6%), mixed‐states (24.3%), depression (19.5%), or apparent nonaffective psychosis (14.6%). Antecedent morbidity presented 12.7 years before first‐episodes (ages: SzAffD≤BD‐I<MDD). Long‐term %‐of‐days‐ill ranked: SzAffD (83.0%), MDD (57.8%), BD‐I (45.0%). Morbidity differed by diagnosis and first‐episode types, was predicted by first‐episodes, and suggested by antecedent illnesses. Long‐term wellness was greater with: BD‐I diagnosis, first‐episode not mixed or psychotic‐nonaffective, rapid‐onset, and being older at first antecedents, but not follow‐up duration.
Conclusions
Initially psychotic BD‐I, SzAffD, or MDD subjects followed for 4.47 years from first‐hospitalization experienced much illness, especially depressive or dysthymic, despite ongoing clinical treatment. Antecedent symptoms arose years before index first‐episodes; they and first‐episode types predicted types and amounts of long‐term morbidity, which ranked: SzAffD > BD‐I > MDD.