This proposed study will investigate the trajectories of recovery over the two decades after first admission in a large representative sample of affective and non-affective psychoses, the only such cohort followed long-term in the US. The proposed study will provide epidemiologic data on prevalence, distribution, and development of long-term recovery. Such information is essential for sound planning of the public health policy and accurate prognostication in clinical settings, but it is currently lacking. We will examine recovery across its many facets, including clinical, occupational, financial, social, cognitive, neurobiological, subjective, and consumer-defined domains. We also will investigate a range of potential predictors of recovery and will develop algorithms to help clinicians identify patients at risk for poor outcomes. Similarly, we will investigate other problems of high public health significance (e.g., homelessness, incarceration, and medical conditions). Furthermore, we will document the extent of unmet need for care in this population. The application is aligned with the NIMH Strategic Plan in seeking to (1) chart trajectories of psychotic disorders from an early phase of the illness and (2) elucidate links between neurobiological functioning and real-world performance in these conditions. The cohort was originally recruited in the early 1990s from all of the inpatient facilities in a large county and was interviewed multiple times over a 10-year period. At each point, study psychiatrists formulated consensus longitudinal diagnoses. At the 10-year mark, we interviewed 470 cohort members (80.2% response rate), and we found that many had not achieved recovery. However, it has long been hypothesized that functioning improves during the second decade of the illness. Moreover, growing availability of recovery-oriented treatments over the last 10 years is expected to bolster rates of recovery. These predictions will be tested by assessing the cohort two decades after the first hospitalization. A major challenge in studying recovery is the lack of empirical benchmarks for defining it. To address this problem, we will recruit a demographically-matched control group and use its performance to anchor outcomes. We plan to assess 425 cohort members and 425 controls using a state-of-the-art battery of measures. We will interview participants and relatives, review medical records, and administer neuropsychological and electrophysiological assessments. This design offers statistical power to detect even small changes in functioning and will produce normative data that will enable this and other studies to define recovery with rigor and precision. This will be the first study to investigate long-term recovery from psychosis in an epidemiologic first-admission sample and provide an unbiased picture of the scope of the problem.

Public Health Relevance

The aim of this project is to investigate recovery from serious mental illnesses, such as schizophrenia and bipolar disorder, over 20 years and to identify factors that lead to better or worse outcomes. This research will produce a detailed and unbiased picture of outcomes of public concern, such as illness remission, employment, and homelessness. This information can guide improvement in care for serious mental illness.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Study Section
Adult Psychopathology and Disorders of Aging Study Section (APDA)
Program Officer
Rubio, Mercedes
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State University New York Stony Brook
Schools of Medicine
Stony Brook
United States
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Kotov, Roman; Foti, Dan; Li, Kaiqiao et al. (2016) Validating dimensions of psychosis symptomatology: Neural correlates and 20-year outcomes. J Abnorm Psychol 125:1103-1119
Foti, Dan; Perlman, Greg; Hajcak, Greg et al. (2016) Impaired error processing in late-phase psychosis: Four-year stability and relationships with negative symptoms. Schizophr Res 176:520-6
Perlman, Greg; Foti, Dan; Jackson, Felicia et al. (2015) Clinical significance of auditory target P300 subcomponents in psychosis: Differential diagnosis, symptom profiles, and course. Schizophr Res 165:145-51
Jackson, Felicia; Foti, Dan; Kotov, Roman et al. (2014) An incongruent reality: the N400 in relation to psychosis and recovery. Schizophr Res 160:208-15
Paksarian, Diana; Mojtabai, Ramin; Kotov, Roman et al. (2014) Perceived trauma during hospitalization and treatment participation among individuals with psychotic disorders. Psychiatr Serv 65:266-9
Kotov, Roman; Leong, Shirley H; Mojtabai, Ramin et al. (2013) Boundaries of schizoaffective disorder: revisiting Kraepelin. JAMA Psychiatry 70:1276-86
David Klonsky, E; Kotov, Roman; Bakst, Shelly et al. (2012) Hopelessness as a predictor of attempted suicide among first admission patients with psychosis: a 10-year cohort study. Suicide Life Threat Behav 42:1-10
Carlson, Gabrielle A; Kotov, Roman; Chang, Su-Wei et al. (2012) Early determinants of four-year clinical outcomes in bipolar disorder with psychosis. Bipolar Disord 14:19-30
Foti, Dan; Kotov, Roman; Bromet, Evelyn et al. (2012) Beyond the broken error-related negativity: functional and diagnostic correlates of error processing in psychosis. Biol Psychiatry 71:864-72
Ruggero, Camilo J; Kotov, Roman; Carlson, Gabrielle A et al. (2011) Diagnostic consistency of major depression with psychosis across 10 years. J Clin Psychiatry 72:1207-13

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